Nursing in critical care · 2025
Older Adult Sepsis Survivors Discharged to Skilled Nursing Facilities: Age-Adjusted Charlson Comorbidity Index as a Predictor of 6-Month Mortality.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Cheng Hongtao, Shao Lu, Wu Huijun, Mi Boya, Li Qiugui, Zhang June
Аннотация
BACKGROUND: Sepsis is a critical global health issue, particularly affecting older adults. Despite advances in acute sepsis management, the long-term outcomes for survivors, particularly those transitioning to skilled nursing facilities (SNFs), remain poorly characterized.
AIM: To evaluate the prognostic value of the age-adjusted Charlson Comorbidity Index (ACCI) in predicting 6-month mortality among older adult sepsis survivors discharged to SNFs.
STUDY DESIGN: An observational cohort study of older adult sepsis patients in the intensive care unit (ICU) of a tertiary academic medical centre in Boston from 2008 to 2019 was performed. Patients were stratified into low (≤ 5), intermediate (6, 7) and high (≥ 8) ACCI score groups. Using the Cox proportional hazards model, we determined the association between ACCI scores and 6-month mortality, calculating hazard ratios (HR) and 95% confidence intervals (CIs). The predictive performance was assessed using ROC curve analysis and compared with Sequential Organ Failure Assessment (SOFA) scores.
RESULTS: The study included 3713 sepsis survivors aged 65 and older discharged to SNFs. The median age was around 80 years, and 52.6% of the participants were female. The analysis revealed that each one-point increase in the ACCI was associated with an 18% higher risk of mortality within 6 months (HR 1.18; 95% CI 1.14-1.22; p < 0.001). Furthermore, compared with individuals with low ACCI scores, those in the moderate ACCI score group had a HR of 1.55 (95% CI: 1.26-1.91, p < 0.001), and those in the high ACCI score group had a HR of 2.43 (95% CI: 1.96-3.03, p < 0.001). ACCI demonstrated superior predictive performance compared with SOFA scores (area under the curve [AUC] 0.65 vs. 0.53, p < 0.001).
CONCLUSIONS: ACCI serves as an independent predictor of 6-month mortality in older adult sepsis survivors discharged to SNFs.
RELEVANCE TO CLINICAL PRACTICE: Critical care nurses can use ACCI as a risk stratification tool to identify high-risk older sepsis survivors, inform discharge planning and improve interprofessional communication for tailored post-acute care interventions in SNFs.
AIM: To evaluate the prognostic value of the age-adjusted Charlson Comorbidity Index (ACCI) in predicting 6-month mortality among older adult sepsis survivors discharged to SNFs.
STUDY DESIGN: An observational cohort study of older adult sepsis patients in the intensive care unit (ICU) of a tertiary academic medical centre in Boston from 2008 to 2019 was performed. Patients were stratified into low (≤ 5), intermediate (6, 7) and high (≥ 8) ACCI score groups. Using the Cox proportional hazards model, we determined the association between ACCI scores and 6-month mortality, calculating hazard ratios (HR) and 95% confidence intervals (CIs). The predictive performance was assessed using ROC curve analysis and compared with Sequential Organ Failure Assessment (SOFA) scores.
RESULTS: The study included 3713 sepsis survivors aged 65 and older discharged to SNFs. The median age was around 80 years, and 52.6% of the participants were female. The analysis revealed that each one-point increase in the ACCI was associated with an 18% higher risk of mortality within 6 months (HR 1.18; 95% CI 1.14-1.22; p < 0.001). Furthermore, compared with individuals with low ACCI scores, those in the moderate ACCI score group had a HR of 1.55 (95% CI: 1.26-1.91, p < 0.001), and those in the high ACCI score group had a HR of 2.43 (95% CI: 1.96-3.03, p < 0.001). ACCI demonstrated superior predictive performance compared with SOFA scores (area under the curve [AUC] 0.65 vs. 0.53, p < 0.001).
CONCLUSIONS: ACCI serves as an independent predictor of 6-month mortality in older adult sepsis survivors discharged to SNFs.
RELEVANCE TO CLINICAL PRACTICE: Critical care nurses can use ACCI as a risk stratification tool to identify high-risk older sepsis survivors, inform discharge planning and improve interprofessional communication for tailored post-acute care interventions in SNFs.