重症监护室治疗败血症后的功能依赖性:前瞻性中德败血症队列(MSC)的三年随访结果

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Europe Pub Date : 2024-09-12 DOI:10.1016/j.lanepe.2024.101066
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引用次数: 0

摘要

背景脓毒症存活后会导致慢性生理、心理和认知障碍,这影响着全球数百万患者,包括 COVID-19 病毒性脓毒症后的幸存者。我们进行了一项前瞻性队列研究,研究对象包括从德国五家重症监护病房(ICU)出院的脓毒症幸存者,直至出院后 36 个月。主要结果是功能依赖性,定义为日常生活活动(ADL;10 项 ADL 评分 <100)≥1 次受损、自我报告的护理依赖性或护理级别。次要结果是败血症后在身体、心理或认知领域的发病率。我们使用了多态竞争风险模型来处理依赖过程中的竞争事件,并进行了多元线性回归分析,以确定与 ADL 评分相关的预测因素。共有 753 人被纳入中德败血症队列的随访评估中。患者的中位年龄为65岁(Q1-Q3为56-74岁),64.8%(488/753)为男性,76.1%(573/753)患有脓毒性休克。考虑到竞争风险模型,在脓毒症发生后的三年内,仍有功能依赖的概率约为 25%,而恢复功能独立的概率约为 30%,死亡概率为 45%。据患者报告,败血症后三年内新出现的、往往是重叠的损伤负担很重。在存活三年的亚组(n = 330)中,91.2%(n = 301)的患者出现新的肢体损伤,57.9%(n = 191)和 40.9%(n = 135)的患者出现新的认知和心理损伤。脓毒症存活期与多种新的损伤有关,并导致约四分之一的患者出现功能依赖。需要采取有针对性的措施来减轻脓毒症后综合征的负担,并提高获得功能改善的患者比例。这项工作得到了耶拿大学医院脓毒症控制和护理中心(CSCC)综合研究和治疗中心的支持,该中心由德国教育和研究部以及德国克雷沙的 Rudolf Presl GmbH & Co 赞助。
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Functional dependence following intensive care unit-treated sepsis: three-year follow-up results from the prospective Mid-German Sepsis Cohort (MSC)

Background

Surviving sepsis can lead to chronic physical, psychological and cognitive impairments, which affect millions of patients worldwide, including survivors after COVID-19 viral sepsis. We aimed to characterize the magnitude and trajectory of functional dependence and new impairments post-sepsis.

Methods

We conducted a prospective cohort study including sepsis survivors who had been discharged from five German intensive care units (ICUs), until 36 months post-discharge. Primary outcome was functional dependence, defined as ≥1 impaired activity of daily living (ADL; 10-item ADL score <100), self-reported nursing care dependence or nursing care level. Secondary outcome was post-sepsis morbidity in the physical, psychological or cognitive domain. We used a multistate, competing risk model to address competing events in the course of dependence, and conducted multiple linear regression analyses to identify predictors associated with the ADL score.

Findings

Of 3210 sepsis patients screened, 1968 survived the ICU treatment (61.3%). A total of 753 were included in the follow-up assessments of the Mid-German Sepsis cohort. Patients had a median age of 65 (Q1–Q3 56–74) years, 64.8% (488/753) were male and 76.1% (573/753) had a septic shock. Considering competing risk modelling, the probability of still being functional dependent was about 25%, while about 30% regained functional independence and 45% died within the three years post-sepsis. Patients reported a high burden of new and often overlapping impairments until three years post-sepsis. In the subgroup of three-year survivors (n = 330), new physical impairments affected 91.2% (n = 301) while new cognitive and psychological impairments were reported by 57.9% (n = 191) and 40.9% (n = 135), respectively. Patients with pre-existing functional limitations and higher age were at risk for low ADL scores three years after sepsis.

Interpretation

Sepsis survivorship was associated with a broad range of new impairments and led to functional dependence in around one quarter of patients. Targeted measures are needed to mitigate the burden of this Post-Sepsis-Syndrome and increase the proportion of patients that achieve functional improvements.

Funding

This work was supported by the Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC) at the Jena University Hospital funded by the German Ministry of Education and Research and by the Rudolf Presl GmbH & Co, Kreischa, Germany.

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来源期刊
CiteScore
19.90
自引率
1.40%
发文量
260
审稿时长
9 weeks
期刊介绍: The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.
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