CC:重症监护病房成年幸存者中的抑郁或焦虑与长期死亡率：一项基于人群的队列研究​

Abstract

Background: Many patients who survive intensive care unit (ICU) stays experience persistent mental impairments. It is estimated that one-third of ICU survivors suffer from psychiatric disorders. However, research into how these disorders affect long-term outcomes in this population is scarce. Therefore, the aim of this study is to investigate the association between depression or anxiety and long-term mortality among ICU survivors.

背景​：许多重症监护病房（ICU）存活的患者会经历持续的心理障碍。据估计，三分之一的ICU幸存者患有精神疾病。然而，关于这些心理障碍如何影响该人群长期预后的研究较少。因此，本研究旨在探讨ICU幸存者中抑郁或焦虑与长期死亡率之间的关联。

Methods: This population-based cohort study included patients admitted to the ICU between January 1, 2015 and December 31, 2019, who survived at least 1 year after ICU discharge. Exclusions were made for patients admitted for non-medical reasons and those who had been in the ICU in the previous 2 years, and 799,645 patients were included in the study. Follow-up data were obtained for up to 7 years. The primary outcome was long-term cumulative mortality. Mortality rates for patients with and without diagnoses of depression or anxiety were compared.

方法​：这项基于人群的队列研究纳入了2015年1月1日至2019年12月31日期间入住ICU并至少存活1年的患者。排除了因非医疗原因入院的患者以及在过去2年内曾入住ICU的患者，最终纳入799,645名患者。随访数据最长为7年。主要结局是长期累积死亡率。比较了有和没有抑郁或焦虑诊断患者的死亡率。

Results: Of the 799,645 adult ICU survivors, 98,530 (12.3%) were newly diagnosed with depression or anxiety post-discharge, and 265,092 (33.2%) had been diagnosed prior to ICU admission. Multivariate Cox proportional hazards regression analysis revealed that the adjusted hazard ratio (HR) for long-term mortality was 1.17 (95% CI, 1.16-1.19) for those newly diagnosed with depression or anxiety, 1.28 (95% CI, 1.26-1.30) for depression alone, and 1.08 (95% CI, 1.06-1.11) for anxiety alone. For those with prior diagnoses, the adjusted HR was 1.08 (95% CI, 1.07-1.09) overall, 1.12 (95% CI, 1.11-1.14) for depression, and 1.04 (95% CI, 1.03-1.05) for anxiety.

结果​：在799,645名成年ICU幸存者中，98,530名（12.3%）在出院后被新诊断为抑郁或焦虑，265,092名（33.2%）在ICU入院前已有诊断。多变量Cox比例风险回归分析显示，对于新诊断为抑郁或焦虑的患者，长期死亡率的调整风险比（HR）为1.17（95% CI，1.16-1.19）；仅抑郁为1.28（95% CI，1.26-1.30）；仅焦虑为1.08（95% CI，1.06-1.11）。对于之前已有诊断的患者，调整HR总体为1.08（95% CI，1.07-1.09）；仅抑郁为1.12（95% CI，1.11-1.14）；仅焦虑为1.04（95% CI，1.03-1.05）。

Conclusions: ICU survivors newly diagnosed with depression or anxiety exhibit higher long-term mortality rates compared to those without such diagnoses, including those diagnosed before ICU admission. Particularly, newly diagnosed depression is associated with an elevated mortality rate. These findings underscore the need for psychological interventions to enhance long-term survival among ICU survivors.

结论​：与没有抑郁或焦虑诊断的患者（包括ICU入院前已有诊断的患者）相比，ICU幸存者中新诊断为抑郁或焦虑的患者表现出更高的长期死亡率。特别是新诊断的抑郁与死亡率升高显著相关。这些发现强调了需要心理干预以提高ICU幸存者的长期生存率。