ABSTRACT
OBJETIVO: Avaliar a confiabilidade do SF-36 para pacientes graves no período anterior à admissão em unidade de terapia intensiva e mensurar a qualidade de vida relacionada à saúde prévia e sua relação com a gravidade da doença e o tempo de permanência em unidade de terapia intensiva. MÉTODOS: Estudo de coorte prospectivo realizado em unidades de terapia intensiva de um hospital escola público. Foram entrevistados 91 pacientes comunicativos e orientados nas primeiras 72 horas de admissão nas unidades de terapia intensiva durante 3 meses. O escore APACHE II foi utilizado para avaliar a gravidade da doença e o questionário SF-36 para avaliar a qualidade de vida relacionada à saúde. RESULTADOS: A confiabilidade do SF-36 foi avaliada em todas as dimensões por meio do coeficiente alfa de Cronbach. Em seis, de oito dimensões, o valor excedeu 0,70. As médias dos escores do SF-36 para pacientes críticos referentes ao período anterior à admissão em unidades de terapia intensiva foram: 57,8 para capacidade funcional; 32,4 para aspectos físicos; 53,0 para dor; 63,2 para estado geral de saúde; 50,6 para vitalidade; 56,2 para aspectos sociais; 54,6 para aspectos emocionais e 60,3 para saúde mental. As correlações entre gravidade da doença, tempo de permanência e escores da qualidade de vida relacionada à saúde foram muito baixas, variando de -0,152 a 0,175 e -0,158 a 0,152, respectivamente. CONCLUSÃO : O SF-36 demonstrou boa confiabilidade quando utilizado para medir qualidade de vida relacionada à saúde em pacientes críticos antes da admissão em unidade de terapia intensiva. O domínio com maior comprometimento prévio foi aspectos físicos e o melhor foi o estado geral de saúde. A qualidade de vida relacionada à saúde prévia dos pacientes não se correlacionou com a gravidade da doença e o tempo de permanência em unidade de terapia intensiva.
OBJECTIVE: To examine the reliability of the SF-36 general health questionnaire when used to evaluate the health status of critically ill patients before admission to intensive care and to measure their health-related quality of life prior to admission and its relation to severity of illness and length of stay in the intensive care unit. METHODS: Prospective cohort study conducted in the intensive care unit of a public teaching hospital. Over three months, communicative and oriented patients were interviewed within the first 72 hours of intensive care unit admission; 91 individuals participated. The APACHE II score was used to assess severity of illness, and the SF-36 questionnaire was used to measure health-related quality of life. RESULTS: The reliability of SF-36 was verified in all dimensions using Cronbach's alpha coefficient. In six dimensions of eight domains the value exceeded 0.70. The average SF-36 scores of the health-related quality of life dimensions for the patients before admission to intensive care unit were 57.8 for physical functioning, 32.4 for role-physical, 53.0 for bodily pain, 63.2 for general health, 50.6 for vitality, 56.2 for social functioning, 54.6 for role-emotional and 60.3 for mental health. The correlations between severity of illness and length of stay and the health-related quality of life scores were very low, ranging from -0.152 to 0.175 and -0.158 to 0.152, respectively, which were not statistically significant. CONCLUSION: In the sample studied, the SF-36 demonstrated good reliability when used to measure health-related quality of life in critically ill patients before admission to the intensive care unit. The worst score was role-physical and the best was general health. Health-related quality of life of patients before admission was not correlated with severity of illness or length of stay in the intensive care unit.
ABSTRACT
OBJECTIVES: This study aimed to assess the impact of the duration of organ dysfunction on the outcome of patients with severe sepsis or septic shock. METHODS: Clinical data were collected from hospital charts of patients with severe sepsis and septic shock admitted to a mixed intensive care unit from November 2003 to February 2004. The duration of organ dysfunction prior to diagnosis was correlated with mortality. Results were considered significant if p<0.05. RESULTS: Fifty-six patients were enrolled. Mean age was 55.6 ± 20.7 years, mean APACHE II score was 20.6 ± 6.9, and mean SOFA score was 7.9 ± 3.7. Thirty-six patients (64.3 percent) had septic shock. The mean duration of organ dysfunction was 1.9 ± 1.9 days. Within the univariate analysis, the variables correlated with hospital mortality were: age (p=0.015), APACHE II (p=0.008), onset outside the intensive care unit (p=0.05), blood glucose control (p=0.05) and duration of organ dysfunction (p=0.0004). In the multivariate analysis, only a duration of organ dysfunction persisting longer than 48 hours correlated with mortality (p=0.004, OR: 8.73 (2.37-32.14)), whereas the APACHE II score remained only a slightly significant factor (p=0.049, OR: 1.11 (1.00-1.23)). Patients who received therapeutic interventions within the first 48 hours after the onset of organ dysfunction exhibited lower mortality (32.1 percent vs. 82.1 percent, p=0.0001). CONCLUSIONS: These findings suggest that the diagnosis of organ dysfunction is not being made in a timely manner. The time elapsed between the onset of organ dysfunction and initiation of therapeutic intervention can be quite long, and this represents an important determinant of survival in cases of severe sepsis and septic shock.