Functional outcomes of general medical patients with severe sepsis

BMC Infectious Diseases

Theodore J Iwashyna⁵  Scott A Flanders³  Lena M Chen¹  Preeti N Malani⁴  Latoya Kuhn⁵  Catherine Bonham²  Jeffrey M Rohde³  Andrew J Odden³ 

[1] Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA;Section of Pulmonary and Critical Care Medicine, The University of Chicago, 5841 South Maryland Avenue, MC 6092, MC6076, Chicago, IL 60637, USA;Department of Medicine, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA;Geriatrics Research and Education Center, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA;Center for Clinical Management Research, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA

关键词: Sepsis;    Disability;    Non-ICU;    General ward;    Geriatrics;    Functional outcomes;    Severe sepsis;   

Others  :  1137810
DOI  :  10.1186/1471-2334-13-588

 received in 2013-04-21, accepted in 2013-12-06,  发布年份 2013

【 摘 要 】

Background

Severe sepsis is a common cause for admission to the general medical ward. Previous work has demonstrated substantial new long-term disability in patients with severe sepsis, but the short-term functional outcomes of patients admitted to the general medical floor -- where the majority of severe sepsis is treated -- are largely unknown.

Methods

A retrospective cohort study was performed of patients initially admitted to non-ICU medical wards at a tertiary care academic medical center. Severe sepsis was confirmed by three physician reviewers, using the International Consensus Conference definition of sepsis. Baseline functional status, disposition location, and receipt of post-acute skilled care were recorded using a structured abstraction instrument.

Results

3,146 discharges had severe sepsis by coding algorithm; from a random sample of 111 patients, 64 had the diagnosis of severe sepsis confirmed by reviewers. The mean age of the 64 patients was 63.5 years +/- 18.0. Prior to admission, 80% of patients lived at home and 50.8% of patients were functionally independent. Inpatient mortality was 12.5% and 37.5% of patients were discharged to a nursing facility. Of all patients in the cohort, 50.0% were discharged home, and 66.7% of patients who were functionally independent at baseline were discharged to home.

Conclusions

New physical debility is a common feature of severe sepsis in patients initially cared for on the general medical floor. Debility occurs even in those with good baseline physical function. Interventions to improve the poor functional outcomes of this population are urgently needed.

【 授权许可】

   
2013 Odden et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992, 101(6):1644-1655.
• [2]Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003, 31(4):1250-1256.
• [3]Angus DC, Wax RS: Epidemiology of sepsis: an update. Crit Care Med 2001, 29(7 Suppl):S109-S116.
• [4]Yende S, Angus DC: Long-term outcomes from sepsis. Curr Infect Dis Rep 2007, 9(5):382-386.
• [5]Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001, 29(7):1303-1310.
• [6]Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM: Population burden of long-term survivorship after severe sepsis in older Americans. J Am Geriatr Soc 2012, 60(6):1070-1077.
• [7]Martin GS, Mannino DM, Eaton S, Moss M: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003, 348(16):1546-1554.
• [8]Iwashyna TJ, Ely EW, Smith DM, Langa KM: Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010, 304(16):1787-1794.
• [9]Karlsson S, Ruokonen E, Varpula T, Ala-Kokko TI, Pettila V: Long-term outcome and quality-adjusted life years after severe sepsis. Crit Care Med 2009, 37(4):1268-1274.
• [10]Winters BD, Eberlein M, Leung J, Needham DM, Pronovost PJ, Sevransky JE: Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med 2010, 38(5):1276-1283.
• [11]Elixhauser, A. (Agency for Healthcare Research and Quality), Friedman, B. (Agency for Healthcare Research and Quality) and Stranges, E. (Thomson Reuters): Septicemia in U.S. Hospitals, 2009. HCUP Statistical Brief #122. Rockville, MD: Agency for Healthcare Research and Quality; 2011. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb122.pdf webcite
• [12]Lagu T, Rothberg MB, Nathanson BH, Pekow PS, Steingrub JS, Lindenauer PK: The relationship between hospital spending and mortality in patients with sepsis. Arch Intern Med 2011, 171(4):292-299.
• [13]Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK: Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med 2012, 40(3):754-761.
• [14]Quartin AA, Schein RM, Kett DH, Peduzzi PN: Magnitude and duration of the effect of sepsis on survival. Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group. JAMA 1997, 277(13):1058-1063.
• [15]Esteban A, Frutos-Vivar F, Ferguson ND, Penuelas O, Lorente JA, Gordo F, Honrubia T, Algora A, Bustos A, Garcia G, et al.: Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med 2007, 35(5):1284-1289.
• [16]Sundararajan V, Macisaac CM, Presneill JJ, Cade JF, Visvanathan K: Epidemiology of sepsis in Victoria, Australia. Crit Care Med 2005, 33(1):71-80.
• [17]Iwashyna TJ, Odden A, Rohde J, Bonham C, Kuhn L, Malani P, Chen L, Flanders S: Identifying Patients With Severe Sepsis Using Administrative Claims: patient-level validation of the angus implementation of the International Consensus Conference Definition of Severe Sepsis. Med Care 2012.
• [18]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40(5):373-383.
• [19]Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW: Studies of Illness in the Aged. The Index of Adl: a Standardized Measure of Biological and Psychosocial Function. JAMA 1963, 185(12):914-919.
• [20]HCUP Nationwide Inpatient Sample (NIS): Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2010. http://www.hcup-us.ahrq.gov/nisoverview.jsp webcite
• [21]HCUPnet: Hospitalizations for Congestive Heart Failure with Major Cormorbid Conditions in 2010: Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Rockville, MD: Agency for Healthcare Research and Quality; http://hcupnet.ahrq.gov/ webcite Accessed July 12, 2012
• [22]Krumholz HM: Post-hospital syndrome–an acquired, transient condition of generalized risk. N Engl J Med 2013, 368(2):100-102.
• [23]Covinsky KE, Pierluissi E, Johnston CB: Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure". JAMA 2011, 306(16):1782-1793.
• [24]Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, et al.: Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009, 373(9678):1874-1882.
• [25]Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, Hermans G, Decramer M, Gosselink R: Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009, 37(9):2499-2505.
• [26]Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, et al.: Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008, 36(8):2238-2243.
• [27]Mundy LM, Leet TL, Darst K, Schnitzler MA, Dunagan WC: Early mobilization of patients hospitalized with community-acquired pneumonia. Chest 2003, 124(3):883-889.
• [28]Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, et al.: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36(1):296-327.
• [29]Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345(19):1368-1377.