The Development of Chronic Critical Illness Determines Physical Function, Quality of Life, and Long-Term Survival Among Early Survivors of Sepsis in Surgical ICUs.
Crit Care Med
; 47(4): 566-573, 2019 04.
Article
em En
| MEDLINE
| ID: mdl-30664526
ABSTRACT
OBJECTIVES:
This study sought to examine mortality, health-related quality of life, and physical function among sepsis survivors who developed chronic critical illness.DESIGN:
Single-institution, prospective, longitudinal, observational cohort study assessing 12-month outcomes.SETTING:
Two surgical/trauma ICUs at an academic tertiary medical and level 1 trauma center. PATIENTS Adult critically ill patients that survived 14 days or longer after sepsis onset.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
Baseline patient characteristics and function, sepsis severity, and clinical outcomes of the index hospitalization were collected. Follow-up physical function (short physical performance battery; Zubrod; hand grip strength) and health-related quality of life (EuroQol-5D-3L, Short Form-36) were measured at 3, 6, and 12 months. Hospital-free days and mortality were determined at 12 months. We compared differences in long-term outcomes between subjects who developed chronic critical illness (≥ 14 ICU days with persistent organ dysfunction) versus those with rapid recovery. The cohort consisted of 173 sepsis patients; 63 (36%) developed chronic critical illness and 110 (64%) exhibited rapid recovery. Baseline physical function and health-related quality of life did not differ between groups. Those who developed chronic critical illness had significantly fewer hospital-free days (196 ± 148 vs 321 ± 65; p < 0.0001) and reduced survival at 12-months compared with rapid recovery subjects (54% vs 92%; p < 0.0001). At 3- and 6-month follow-up, chronic critical illness patients had significantly lower physical function (3 mo short physical performance battery, Zubrod, and hand grip; 6 mo short physical performance battery, Zubrod) and health-related quality of life (3- and 6-mo EuroQol-5D-3L) compared with patients who rapidly recovered. By 12-month follow-up, chronic critical illness patients had significantly lower physical function and health-related quality of life on all measures.CONCLUSIONS:
Surgical patients who develop chronic critical illness after sepsis exhibit high healthcare resource utilization and ultimately suffer dismal long-term clinical, functional, and health-related quality of life outcomes. Further understanding of the mechanisms driving the development and persistence of chronic critical illness will be necessary to improve long-term outcomes after sepsis.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
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4_TD
Base de dados:
MEDLINE
Assunto principal:
Qualidade de Vida
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Indicadores Básicos de Saúde
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Estado Terminal
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Sobreviventes
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Sepse
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
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Patient_preference
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Crit Care Med
Ano de publicação:
2019
Tipo de documento:
Article