败血症的一年预后:日本一项前瞻性多中心队列研究

IF 3.8 2区 医学 Q1 CRITICAL CARE MEDICINE
Keibun Liu, Shinichi Watanabe, Kensuke Nakamura, Hidehiko Nakano, Maiko Motoki, Hiroshi Kamijo, Matsuoka Ayaka, Kenzo Ishii, Yasunari Morita, Takashi Hongo, Nobutake Shimojo, Yukiko Tanaka, Manabu Hanazawa, Tomohiro Hamagami, Kenji Oike, Daisuke Kasugai, Yutaka Sakuda, Yuhei Irie, Masakazu Nitta, Kazuki Akieda, Daigo Shimakura, Hajime Katsukawa, Toru Kotani, David McWilliams, Peter Nydahl, Stefan J Schaller, Takayuki Ogura
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引用次数: 0

摘要

背景:脓毒症是重症监护病房(ICU)的主要死亡原因。脓毒症幸存者往往留下显著的发病率,称为重症监护后综合征(PICS),影响脓毒症后的生活。目的是提供日本ICU脓毒症患者预后和功能长期结局的详细数据,目前缺乏这些数据,因此阻碍了有针对性解决方案的开发。方法:一项多中心前瞻性研究,包括日本20家三级医院的21个ICU,纳入2020年11月至2022年4月期间所有在ICU入院时诊断为脓毒症(sepsis 3)的连续成人ICU患者。分别于出院后3、6、12个月通过电话和邮件进行随访。主要结局为PICS的死亡或发生率,定义为躯体功能障碍(Barthel指数≤90)、认知功能障碍(短记忆问卷结果:共纳入339例患者(中位年龄74[67-82]岁,60%为男性,77%为感染性休克,中位SOFA为9[6-12])。出院时死亡率为23%,12个月时上升至37%。出院时符合PICS标准的患者死亡率为89%,3个月、6个月和12个月时的死亡率或PICS发生率分别为73%、64%和65%。在第一年,生活质量和重返工作岗位的改善有限(44%),再入院率高(40%),频繁使用急诊服务(31%),以及康复和精神科服务的使用率低(15%和7%)。在随后的随访中,任何与pics相关的功能障碍的发生率始终是相同功能障碍发生率的独立因素。结论:这项多中心研究确定了日本ICU患者脓毒症后生活的独特现实,强调了改善其功能和恢复日常生活的独特挑战。试点注册大学医院医疗信息网UMIN000041433。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
One-year outcomes in sepsis: a prospective multicenter cohort study in Japan.

Background: Sepsis is a leading cause of death in intensive care units (ICU). Sepsis survivors are often left with significant morbidity, termed post-intensive care syndrome (PICS), impacting post-sepsis life. The aim was to present detailed data on the prognostic and functional long-term outcomes of ICU patients with sepsis in Japan, which is currently lacking and therefore prevents development of targeted solutions.

Methods: A multicenter prospective study, involving 21 ICUs in 20 tertiary hospitals in Japan, included all consecutive adult ICU patients between November 2020 and April 2022, and diagnosed with sepsis at ICU admission (Sepsis 3). Follow-ups were performed at 3, 6, and 12 months after hospital discharge by telephone and mail. Primary outcome was death or incidence of PICS, defined by any of physical dysfunction (Barthel Index ≤ 90), cognitive dysfunction (Short Memory Questionnaire < 40), or mental disorder (any subscales for anxiety or depression of Hospital Anxiety and Depression Scale ≥ 8, or Impact of Event Scale-Revised ≥ 25). Secondary outcomes included Quality of Life (QOL), employment, and use of hospital, emergency, rehabilitation, and psychiatric services. A multivariable analysis investigated independent factors associated with each dysfunction at each follow-up.

Results: A total of 339 patients were included (median age 74 [67-82] years, 60% male, 77% septic shock, and a median SOFA of 9 [6-12]). Mortality was 23% at hospital discharge, increasing to 37% at 12 months. The rate of death for those who met PICS Criteria at hospital discharge was 89%, with a death or PICS incidence of 73%, 64%, and 65% at 3, 6, and 12 months, respectively. Limited improvements in QOL and return to work (44%), high rates of hospital readmissions (40%), frequent emergency service usage (31%), and low utilization of rehabilitation and psychiatric services (15% and 7%) were identified over the first year. The incidence of any PICS-related dysfunction was consistently an independent factor for the incidence of the same dysfunction at the following follow-ups.

Conclusions: This multicenter study identified the distinct realities of post-sepsis life in Japanese ICU patients, highlighting the unique challenges in improving their functions and returning to daily life. Trial Registration University Hospital Medical Information Network UMIN000041433.

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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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