老人家，sepsis來住院，認知功能退化
老人家，住一次院就全垮了(真的目前都是遇到sepsis的病人會這樣，其它的不太會)
acute delirium, 失禁，睡眠失常
家人常常會回來抱怨
如果是長期在門診看的病人還好，可以知道抱怨的真假
但有時候是第一次看的病人，那就要看家人的可信度了……
通常外勞的話比家人可信，孫子/女輩的話比第二代可信…哈哈哈
anyway....只要確定沒有其它問題，通常隨時間會改善，1-2 weeks maybe
Cognitive Decline After Sepsis Hospitalization
Older patients hospitalized with severe sepsis are at increased risk for new cognitive deficits and functional impairment, highlighting their need for subacute and chronic follow-up.
In this observational study, investigators explored the effects of sepsis on cognition and performance of activities of daily living (ADLs). The authors conducted biennial structured interviews of 9223 elders (or their proxies) who were participating in an ongoing cohort study with linked Medicare data. More than 500 were survivors of severe sepsis (defined as new infection with organ failure) and had at least one follow-up interview after sepsis during the 8-year study.
According to previously validated, yet not widely used, cognitive screening methods and cut points, moderate-to-severe cognitive impairment was significantly greater after sepsis than before sepsis occurred (odds ratio, 3.34; 95% confidence interval, 1.53–7.25). The comparable odds ratio after a nonsepsis hospitalization (affecting about 4000 study participants) was nonsignificant. A functional outcome score based on ability to perform ADLs and instrumental ADLs likewise revealed a greater decline and an acceleration of a negative functional trajectory after sepsis versus nonsepsis hospitalizations, although no single functional activity was identified as consistently impaired. To address potential confounders, subgroup analyses adjusting for mechanical ventilation, prehospital functional impairment, and interval hospitalizations (between baseline and sepsis) yielded similar findings, albeit with wider confidence intervals.
Comment: The authors acknowledge study limitations, including the lack of a prospective clinical cognitive evaluation and the potential for concomitant diagnoses that could contribute to cognitive and functional impairment but that the charge-based coding strategy could not capture. Also, the interviews preceding sepsis hospitalization show a trend toward advancing cognitive impairment, which may suggest a more insidious mechanism for the reported cognitive decline. However, this analysis will heighten awareness of the long-term outcomes of a relatively common and increasingly survivable condition in hospitalized patients that is currently managed using an acute-care model. These findings presumably will lead to greater scrutiny of "successful" treatment of severe sepsis with the goal of improving long-term patient outcomes.
— Brandy R. Matthews, MD
Published in Journal Watch Neurology November 23, 2010
Citation(s):
Iwashyna TJ et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010 Oct 27; 304:1787.
* Original article (Subscription may be required)
* Medline abstract (Free)
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7YmYxZjg5MzItM2IwYy00OTc3LTg0ZTQtMzU3ODY3YmUzYzlj&hl=zh_TW
acute delirium, 失禁，睡眠失常
家人常常會回來抱怨
如果是長期在門診看的病人還好，可以知道抱怨的真假
但有時候是第一次看的病人，那就要看家人的可信度了……
通常外勞的話比家人可信，孫子/女輩的話比第二代可信…哈哈哈
anyway....只要確定沒有其它問題，通常隨時間會改善，1-2 weeks maybe
Cognitive Decline After Sepsis Hospitalization
Older patients hospitalized with severe sepsis are at increased risk for new cognitive deficits and functional impairment, highlighting their need for subacute and chronic follow-up.
In this observational study, investigators explored the effects of sepsis on cognition and performance of activities of daily living (ADLs). The authors conducted biennial structured interviews of 9223 elders (or their proxies) who were participating in an ongoing cohort study with linked Medicare data. More than 500 were survivors of severe sepsis (defined as new infection with organ failure) and had at least one follow-up interview after sepsis during the 8-year study.
According to previously validated, yet not widely used, cognitive screening methods and cut points, moderate-to-severe cognitive impairment was significantly greater after sepsis than before sepsis occurred (odds ratio, 3.34; 95% confidence interval, 1.53–7.25). The comparable odds ratio after a nonsepsis hospitalization (affecting about 4000 study participants) was nonsignificant. A functional outcome score based on ability to perform ADLs and instrumental ADLs likewise revealed a greater decline and an acceleration of a negative functional trajectory after sepsis versus nonsepsis hospitalizations, although no single functional activity was identified as consistently impaired. To address potential confounders, subgroup analyses adjusting for mechanical ventilation, prehospital functional impairment, and interval hospitalizations (between baseline and sepsis) yielded similar findings, albeit with wider confidence intervals.
Comment: The authors acknowledge study limitations, including the lack of a prospective clinical cognitive evaluation and the potential for concomitant diagnoses that could contribute to cognitive and functional impairment but that the charge-based coding strategy could not capture. Also, the interviews preceding sepsis hospitalization show a trend toward advancing cognitive impairment, which may suggest a more insidious mechanism for the reported cognitive decline. However, this analysis will heighten awareness of the long-term outcomes of a relatively common and increasingly survivable condition in hospitalized patients that is currently managed using an acute-care model. These findings presumably will lead to greater scrutiny of "successful" treatment of severe sepsis with the goal of improving long-term patient outcomes.
— Brandy R. Matthews, MD
Published in Journal Watch Neurology November 23, 2010
Citation(s):
Iwashyna TJ et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010 Oct 27; 304:1787.
* Original article (Subscription may be required)
* Medline abstract (Free)
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7YmYxZjg5MzItM2IwYy00OTc3LTg0ZTQtMzU3ODY3YmUzYzlj&hl=zh_TW
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