The post-discharge prognosis of patients with sepsis remains a crucial issue; however, few studies have investigated the relationship between pre-sepsis health status and subsequent prognosis in a large population. This study aimed to examine the effect of the pre-sepsis care needs level on changes in care needs and mortality in patients with sepsis 1 year post-discharge. This was a population-based retrospective cohort study including twelve municipalities in Japan that participated in the Longevity Improvement & Fair Evidence study between April 2014 and March 2022, with a total of 1,491,608 persons. The pre-hospitalization levels of care needs (baseline) were classified from low to high, as no care needs, support level and care needs level 1, care needs levels 2–3, and care needs levels 4–5 (fully dependent). The outcomes were changes in care needs level and mortality 1 year post-discharge, assessed by baseline care needs level using Cox proportional hazard models. The care needs levels of 17,648 patients analyzed at baseline were as follows: no care needs, 7982 (45.2%); support level and care needs level 1, 3736 (21.2%); care needs levels 2–3, 3089 (17.5%); and care needs levels 4–5, 2841 (16.1%). At 1 year post-discharge, the distribution of care needs were as follows: no care needs, 4791 (27.1%); support level and care needs level 1, 2390 (13.5%); care needs levels 2–3, 2629 (14.9%); care needs levels 4–5, 3373 (19.1%); and death, 4465 (25.3%). Patients with higher levels of care needs exhibited an increased association of all-cause mortality 1 year post-discharge after adjusting for confounders [hazard ratios and 95% confidence intervals: support level and care needs level 1, 1.05 (0.96, 1.15); care needs levels 2–3, 1.46 (1.33, 1.60); and care needs levels 4–5, 1.92 (1.75, 2.10); P for trend < 0.001]. Elevated care needs and mortality were observed in patients with sepsis within 1 year post-discharge. Older patients with sepsis and higher baseline levels of care needs had a high association of all-cause mortality 1 year post-discharge.

中文翻译：

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老年脓毒症患者出院后功能结局


脓毒症患者的出院后预后仍然是一个关键问题;然而，很少有研究调查大量人群中脓毒症前健康状况与后续预后之间的关系。本研究旨在检查脓毒症前护理需求水平对脓毒症患者出院 1 年护理需求和死亡率变化的影响。这是一项基于人群的回顾性队列研究，包括了在2014年4月至2022年3月期间参与长寿改善和公平证据研究的日本十二个城市，共有1,491,608人。住院前护理需求水平（基线）从低到高分类，为无护理需求、支持水平和护理需求 1 级、护理需求 2-3 级和护理需求 4-5 级（完全依赖）。结局是出院后 1 年护理需求水平和死亡率的变化，使用 Cox 比例风险模型通过基线护理需求水平进行评估。基线时分析的 17,648 名患者的护理需求水平如下：无护理需求，7982 名 （45.2%）;支持级别和护理需求 1 级，3736 （21.2%）;护理需求 2-3 级，3089 （17.5%）;和 4-5 级护理需求，2841 （16.1%）。出院后 1 年，护理需求分布如下：无护理需求，4791 （27.1%）;支持水平和护理需求 1 级，2390 （13.5%）;护理需求 2-3 级，2629 （14.9%）;护理需求 4-5 级，3373 （19.1%）;死亡 4465 例 （25.3%）。在调整混杂因素后 [风险比和 95% 置信区间：支持水平和护理需求水平 1,1.05 （0.96， 1.15）;护理需求水平 2-3,1.46 （1.33， 1.60);护理需求水平 4-5,1.92 （1.75， 2.10）;趋势 < 的 P 为 0.001]。在脓毒症患者出院后 1 年内观察到护理需求和死亡率升高。老年脓毒症患者和较高基线水平的护理需求在出院后 1 年与全因死亡率高度相关。