Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis

Pei Wen Chao, Chia Jen Shih, Yi Jung Lee, Ching Min Tseng, Shu-Chen Kuo, Yu Ning Shih, Kun Ta Chou, Der Cherng Tarng, Szu Yuan Li, Shuo Ming Ou, Yung Tai Chen

Research output: Contribution to journalArticle

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Abstract

Rationale: Intensive care unit (ICU)-acquired weakness is a common issue for sepsis survivors that is characterized by impaired muscle strength and causes functional disability. Although inpatient rehabilitation has not been found to reduce in-hospital mortality, the impact of postdischarge rehabilitation on sepsis survivors is uncertain. Objectives: To investigate the benefit of postdischarge rehabilitation to long-term mortality in sepsis survivors. Methods: We conducted a nationwide, population-based, high-dimensional propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. The rehabilitation cohort comprised 15,535 ICU patients who survived sepsis and received rehabilitation within 3 months after discharge between 2000 and 2010. The control cohort consisted of 15,535 high-dimensional propensity score-matched subjects who did not receive rehabilitation within 3 months after discharge. The endpoint was mortality during the 10-year follow-up period. Measurements and Main Results: Compared with the control cohort, the rehabilitation cohort had a significantly lower risk of 10-yearmortality (adjusted hazardratio, 0.94; 95% confidence interval, 0.92-0.97; P < 0.001), with an absolute risk reduction of 1.4 per 100 person-years. The frequency of rehabilitation was inversely associated with 10-year mortality (≥3 vs. 1 course: adjusted hazard ratio, 0.82; P < 0.001). Compared with the control cohort, improved survival was observed in the rehabilitation cohort among ill patients who hadmore comorbidities, required more prolonged mechanical ventilation, and had longer ICU or hospital stays, but not among those with the opposite conditions (i.e., less ill patients). Conclusions: Postdischarge rehabilitation may be associated with a reduced risk of 10-year mortality in the subset of patients with particularly long ICU courses.

Original languageEnglish
Pages (from-to)1003-1011
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume190
Issue number9
DOIs
Publication statusPublished - Nov 1 2014

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Intensive Care Units
Survivors
Sepsis
Rehabilitation
Mortality
Propensity Score
Numbers Needed To Treat
National Health Programs
Muscle Strength
Hospital Mortality
Taiwan
Artificial Respiration
Comorbidity
Inpatients
Length of Stay
Cohort Studies
Databases
Confidence Intervals
Survival
Research

Keywords

  • Epidemiology
  • Mortality
  • Rehabilitation
  • Sepsis

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis. / Chao, Pei Wen; Shih, Chia Jen; Lee, Yi Jung; Tseng, Ching Min; Kuo, Shu-Chen ; Shih, Yu Ning; Chou, Kun Ta; Tarng, Der Cherng; Li, Szu Yuan; Ou, Shuo Ming; Chen, Yung Tai.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 190, No. 9, 01.11.2014, p. 1003-1011.

Research output: Contribution to journalArticle

Chao, PW, Shih, CJ, Lee, YJ, Tseng, CM, Kuo, S-C, Shih, YN, Chou, KT, Tarng, DC, Li, SY, Ou, SM & Chen, YT 2014, 'Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis', American Journal of Respiratory and Critical Care Medicine, vol. 190, no. 9, pp. 1003-1011. https://doi.org/10.1164/rccm.201406-1170OC
Chao, Pei Wen ; Shih, Chia Jen ; Lee, Yi Jung ; Tseng, Ching Min ; Kuo, Shu-Chen ; Shih, Yu Ning ; Chou, Kun Ta ; Tarng, Der Cherng ; Li, Szu Yuan ; Ou, Shuo Ming ; Chen, Yung Tai. / Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis. In: American Journal of Respiratory and Critical Care Medicine. 2014 ; Vol. 190, No. 9. pp. 1003-1011.
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abstract = "Rationale: Intensive care unit (ICU)-acquired weakness is a common issue for sepsis survivors that is characterized by impaired muscle strength and causes functional disability. Although inpatient rehabilitation has not been found to reduce in-hospital mortality, the impact of postdischarge rehabilitation on sepsis survivors is uncertain. Objectives: To investigate the benefit of postdischarge rehabilitation to long-term mortality in sepsis survivors. Methods: We conducted a nationwide, population-based, high-dimensional propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. The rehabilitation cohort comprised 15,535 ICU patients who survived sepsis and received rehabilitation within 3 months after discharge between 2000 and 2010. The control cohort consisted of 15,535 high-dimensional propensity score-matched subjects who did not receive rehabilitation within 3 months after discharge. The endpoint was mortality during the 10-year follow-up period. Measurements and Main Results: Compared with the control cohort, the rehabilitation cohort had a significantly lower risk of 10-yearmortality (adjusted hazardratio, 0.94; 95{\%} confidence interval, 0.92-0.97; P < 0.001), with an absolute risk reduction of 1.4 per 100 person-years. The frequency of rehabilitation was inversely associated with 10-year mortality (≥3 vs. 1 course: adjusted hazard ratio, 0.82; P < 0.001). Compared with the control cohort, improved survival was observed in the rehabilitation cohort among ill patients who hadmore comorbidities, required more prolonged mechanical ventilation, and had longer ICU or hospital stays, but not among those with the opposite conditions (i.e., less ill patients). Conclusions: Postdischarge rehabilitation may be associated with a reduced risk of 10-year mortality in the subset of patients with particularly long ICU courses.",
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AU - Chao, Pei Wen

AU - Shih, Chia Jen

AU - Lee, Yi Jung

AU - Tseng, Ching Min

AU - Kuo, Shu-Chen

AU - Shih, Yu Ning

AU - Chou, Kun Ta

AU - Tarng, Der Cherng

AU - Li, Szu Yuan

AU - Ou, Shuo Ming

AU - Chen, Yung Tai

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N2 - Rationale: Intensive care unit (ICU)-acquired weakness is a common issue for sepsis survivors that is characterized by impaired muscle strength and causes functional disability. Although inpatient rehabilitation has not been found to reduce in-hospital mortality, the impact of postdischarge rehabilitation on sepsis survivors is uncertain. Objectives: To investigate the benefit of postdischarge rehabilitation to long-term mortality in sepsis survivors. Methods: We conducted a nationwide, population-based, high-dimensional propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. The rehabilitation cohort comprised 15,535 ICU patients who survived sepsis and received rehabilitation within 3 months after discharge between 2000 and 2010. The control cohort consisted of 15,535 high-dimensional propensity score-matched subjects who did not receive rehabilitation within 3 months after discharge. The endpoint was mortality during the 10-year follow-up period. Measurements and Main Results: Compared with the control cohort, the rehabilitation cohort had a significantly lower risk of 10-yearmortality (adjusted hazardratio, 0.94; 95% confidence interval, 0.92-0.97; P < 0.001), with an absolute risk reduction of 1.4 per 100 person-years. The frequency of rehabilitation was inversely associated with 10-year mortality (≥3 vs. 1 course: adjusted hazard ratio, 0.82; P < 0.001). Compared with the control cohort, improved survival was observed in the rehabilitation cohort among ill patients who hadmore comorbidities, required more prolonged mechanical ventilation, and had longer ICU or hospital stays, but not among those with the opposite conditions (i.e., less ill patients). Conclusions: Postdischarge rehabilitation may be associated with a reduced risk of 10-year mortality in the subset of patients with particularly long ICU courses.

AB - Rationale: Intensive care unit (ICU)-acquired weakness is a common issue for sepsis survivors that is characterized by impaired muscle strength and causes functional disability. Although inpatient rehabilitation has not been found to reduce in-hospital mortality, the impact of postdischarge rehabilitation on sepsis survivors is uncertain. Objectives: To investigate the benefit of postdischarge rehabilitation to long-term mortality in sepsis survivors. Methods: We conducted a nationwide, population-based, high-dimensional propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. The rehabilitation cohort comprised 15,535 ICU patients who survived sepsis and received rehabilitation within 3 months after discharge between 2000 and 2010. The control cohort consisted of 15,535 high-dimensional propensity score-matched subjects who did not receive rehabilitation within 3 months after discharge. The endpoint was mortality during the 10-year follow-up period. Measurements and Main Results: Compared with the control cohort, the rehabilitation cohort had a significantly lower risk of 10-yearmortality (adjusted hazardratio, 0.94; 95% confidence interval, 0.92-0.97; P < 0.001), with an absolute risk reduction of 1.4 per 100 person-years. The frequency of rehabilitation was inversely associated with 10-year mortality (≥3 vs. 1 course: adjusted hazard ratio, 0.82; P < 0.001). Compared with the control cohort, improved survival was observed in the rehabilitation cohort among ill patients who hadmore comorbidities, required more prolonged mechanical ventilation, and had longer ICU or hospital stays, but not among those with the opposite conditions (i.e., less ill patients). Conclusions: Postdischarge rehabilitation may be associated with a reduced risk of 10-year mortality in the subset of patients with particularly long ICU courses.

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KW - Mortality

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