Sepsis Survivors Admitted to Skilled Nursing Facilities
| Autor: | William J. Ehlenbach, Amy J.H. Kind, Ryan P. Westergaard, Andrea Gilmore-Bykovskyi, Michael D. Repplinger, Maureen A. Smith, Elizabeth A. Jacobs |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Activities of daily living genetic structures Statistics as Topic Comorbidity Kaplan-Meier Estimate Critical Care and Intensive Care Medicine Cohort Studies Sepsis 03 medical and health sciences Patient Admission Wisconsin 0302 clinical medicine Risk Factors Activities of Daily Living medicine Humans Cognitive Dysfunction Survivors 030212 general & internal medicine Intensive care medicine Survival analysis Aged Proportional Hazards Models Retrospective Studies Skilled Nursing Facilities Aged 80 and over Proportional hazards model business.industry Retrospective cohort study Cognition medicine.disease Survival Analysis Female business 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Critical Care Medicine. 46:37-44 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/ccm.0000000000002755 |
| Popis: | Severe sepsis survivors frequently experience cognitive and physical functional impairment. The degree of impairment and its association with mortality is understudied, particularly among those discharged to a skilled nursing facility. Our objective was to quantify the cognitive and physical impairment among severe sepsis survivors discharged to a skilled nursing facility and to investigate the relationship between impairment and long-term mortality.Retrospective cohort study.United States.Random 5% sample of Medicare patients discharged following severe sepsis hospitalization, 2005-2009 (n = 135,370).Medicare data were linked with the Minimum Data Set; Minimum Data Set-Cognition Scale was used to assess cognitive function, and the Minimum Data Set activities of daily living hierarchical scale was used to assess functional dependence. Associations were evaluated using multivariable logistic regression, Kaplan-Meier curves, and Cox proportional hazards regression. Of 66,540 beneficiaries admitted to a skilled nursing facility following severe sepsis, 34% had severe or very severe cognitive impairment, and 72.5% had maximal, dependence, or total dependence in activities of daily living. Median survival was 19.4 months for those discharged to a skilled nursing facility without having been in a skilled nursing facility in the preceding 1 year and 10.4 months for those discharged to a skilled nursing facility who had spent time in a skilled nursing facility in the prior year. The adjusted hazard ratio for death was 3.1 for those with very severe cognitive impairment relative to those who were cognitively intact (95% CI, 2.9-3.2; p0.001) and 4.3 for those with "total dependence" in activities of daily livings relative to those who were independent (95% CI, 3.8-5.0; p0.001).Discharge to a skilled nursing facility following severe sepsis hospitalization among Medicare beneficiaries was associated with shorter survival, and cognitive impairment and activities of daily living dependence were each strongly associated with shortened survival. These findings can inform decision-making by patients and physicians and underscores high palliative care needs among sepsis survivors discharged to skilled nursing facility. |
| Databáze: | OpenAIRE |
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