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Niittyvuopio M, Hietanen S, Liisanantti J, Spalding M, Auvinen J, Ala-Kokko T. Health status and quality of life before critical illness: Northern Finland Birth Cohort 1966 study. Acta Anaesthesiol Scand 2024. [PMID: 38938220 DOI: 10.1111/aas.14490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/22/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Previous findings support the claim intensive care unit (ICU) patients have a higher rate of comorbidities and reduction of health- and functional status compared with the normal population. AIM In this prospective observational study, our aim was to determine those health-related factors at the age of 31 years which were associated with a later critical illness among previously un-hospitalized individuals by exploring data obtained from the Northern Finland Birth Cohort 1966 (NFBC1966). METHODS NFBC1966 is a Finnish birth cohort, which includes 12,058 live births with expected dates of delivery during 1966. The study was conducted among cohort participants who had not been hospitalized for any reason before the cohort follow-up visit at the age of 31. The study group included NFBC1966 participants who were admitted to the ICU of the Oulu University Hospital. The control group included participants who were treated for any reason in regular hospital wards. The data considering the participants' health status and behavior at the age of 31 were collected from the NFBC1966 database. The gathering of ICU and hospitalization data was concluded on December 31, 2016. RESULTS 849 NFBC1966 participants met the inclusion criteria: 69 were treated in the ICU (study group) and 780 on regular hospital wards (controls). In the study group, the rate of neurological diseases (26% vs. 16%, 95% CI: -21.8%, -0.2%), malignancy (3% vs. 0.7%, 95% CI: -9.7%, 0.0%), alcohol abuse (4.5% vs. 1%, 95% CI: -11.5%, -0.3%) and smoking (77% vs. 65%, 95% CI: -21.6%, -0.3%) were higher compared with the control group. The patients in the ICU group were also more prone to violent injuries, (17% vs. 7%, 95% CI: -20.2%, -1.9%), practiced less hard physical activity (65% vs. 78%, 95% CI: 2.1%, 25.3%) and had lower maximal muscle strength according to the hand grip test (30 vs. 34 kg, 95% CI: -8.2, 8.6 kg). CONCLUSIONS In this study examining previously un-hospitalized patients, the main factors associated with future critical illness were neurological comorbidities, malignancy, alcohol misuse, smoking, low maximum muscle strength, and less frequent physical exercise compared with those with hospitalization not requiring ICU admission.
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Affiliation(s)
- Miikka Niittyvuopio
- Critical Care Center, Oulu University Hospital and University of Oulu, Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, Oulu, Finland
| | - Siiri Hietanen
- Medical Research Center of Oulu, Research Group of Surgery, Anesthesiology and Intensive Care Medicine, Oulu, Finland
| | - Janne Liisanantti
- Oulu University Hospital, Department of Anesthesiology, University of Oulu and MRC Oulu, Research Unit of Translational Medicine, Oulu, Finland
| | - Michael Spalding
- Critical Care Center, Oulu University Hospital and University of Oulu, Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, Oulu, Finland
| | - Juha Auvinen
- Research unit of Population Health, University of Oulu, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tero Ala-Kokko
- Critical Care Center, Oulu University Hospital and University of Oulu, Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, Oulu, Finland
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Quantifying the burden of the post-ICU syndrome in South Africa: A scoping review of evidence from the public health sector. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2022; 38:10.7196/SAJCC.2022.v38i2.527. [PMID: 36284926 PMCID: PMC9536494 DOI: 10.7196/sajcc.2022.v38i2.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The post-ICU syndrome (PICS) comprises unexpected impairments in physical, cognitive, and mental health after intensive care unit (ICU) discharge, and is associated with a diminished health-related quality of life (HRQOL). A Cochrane review recommended more research in this field from low- and middle-income countries. OBJECTIVES This review aims to examine the extent and nature of publications in the field of PICS in the South African (SA) public health sector. Findings of available local research are contextualised through comparison with international data. METHODS A comprehensive literature search strategy was employed. Inclusion criteria comprised publications enrolling adult patients following admission to SA public hospital ICUs, with the aim to study the main elements of PICS (ICU-acquired neuromuscular weakness, neurocognitive impairment, psychopathology and HRQOL). RESULTS Three studies investigated physical impairment, 1 study psychopathology, and 2 studies HRQOL. Recommended assessment tools were utilised. High rates of attrition were reported. Neuromuscular weakness in shorter-stay patients had recovered at 3 months. Patients who were ventilated for ≥5 days were more likely to be impaired at 6 months. The study on psychopathology reported high morbidity. The HRQOL of survivors was diminished, particularly in patients ventilated for ≥5 days. CONCLUSION This review found a paucity of literature evaluating PICS in the SA public health sector. The findings mirror those from international studies. Knowledge gaps pertaining to PICS in medical, surgical and HIV-positive patients in SA are evident. No publications on neurocognitive impairment or the co-occurrence of PICS elements were identified. There is considerable scope for further research in this field in SA. CONTRIBUTIONS OF THE STUDY This review identified the available publications investigating the post ICU syndrome (PICS) in the South African public healthcare setting. A small number of ground-breaking studies were found. Knowledge gaps in this field were identified.
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Worse pre-admission quality of life is a strong predictor of mortality in critically ill patients. Turk J Phys Med Rehabil 2022; 68:19-29. [PMID: 35949964 PMCID: PMC9305648 DOI: 10.5606/tftrd.2022.5287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/06/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives
In this study, we aimed to investigate whether quality of life (QoL) before intensive care unit (ICU) admission could predict ICU mortality in critically ill patients.
Patients and methods
Between January 2019 and April 2019, a total of 105 ICU patients (54 males, 51 females; mean age: 58 years; range, 18 to 91 years) from two ICUs of a tertiary care hospital were included in this cross-sectional, prospective study. Pre-admission QoL was measured by the Short Form (SF)-12- Physical Component Scores (PCS) and Mental Component Scores (MCS) and EuroQoL five-dimension, five-level scale (EQ-5D-5L) within 24 h of ICU admission and mortality rates were estimated.
Results
The overall mortality rate was 28.5%. Pre-admission QoL was worse in the non-survivors independent from age, sex, socioeconomic and education status, and comorbidities. During the hospitalization, the rate of sepsis and ventilator/hospital-acquired pneumonia were similar among the two groups (p>0.05). Logistic regression analysis adjusted for sex, age, education status, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores showed that pre-admission functional status as assessed by the SF-12 MCS (odds ratio [OR]: 14,2; 95% confidence interval [CI]: 2.5-79.0), SF-12 PCS (OR: 10.6; 95% CI: 1.8-62.7), and EQ-5D-5L (OR: 8.0; 95% CI: 1.5-44.5) were found to be independently associated with mortality.
Conclusion
Worse pre-admission QoL is a strong predictor of mortality in critically ill patients. The SF-12 and EQ-5D-5L scores are both valuable tools for this assessment. Not only the physical status, but also the mental status before ICU admission should be evaluated in terms of QoL to better utilize ICU resources.
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Tugnoli S, Spadaro S, Corte FD, Valpiani G, Volta CA, Caracciolo S. Health Related Quality of Life and Mental Health in ICU Survivors: Post-Intensive Care Syndrome Follow-Up and Correlations between the 36-Item Short Form Health Survey (SF-36) and the General Health Questionnaire (GHQ-28). Health (London) 2022. [DOI: 10.4236/health.2022.145037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Prieto-Palomino MA, Delange-VanDerKroft M, Rodríguez-Rubio D, Lafuente-Baraza J, Aguilar-Alonso E, Rivera-López R, Arias-Verdú MD, Pola-GallegoDeGuzman MD, Muñoz-López A, Fernández-Ortega JF, Curiel-Balsera E, Quesada-Garcia G, Rivera-Fernández R. Improvement of quality of life (QOL) between 1 and 3-4 years after traumatic brain injury (TBI) in ICU patients. Acta Neurochir (Wien) 2020; 162:1619-1628. [PMID: 32405669 DOI: 10.1007/s00701-020-04337-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evaluation of changes in quality of life (QOL) in ICU patients several years after traumatic brain injury (TBI) is not well documented. METHODS A prospective cohort study was conducted in all patients with TBI admitted between 2004 and 2008 to the ICU of Regional Hospital of Malaga (Spain). Functional status was evaluated by Glasgow Outcome Scale (GOS) and QOL by PAECC (Project for the Epidemiologic Analysis of Critical Care patients) questionnaire between 0 (normal QOL) to 29 points (worst QOL). RESULTS A total of 531 patients. Median(Quartile1,Quartile 3) age: 35 (22, 56) years. After 3-4 years, 175 died (33%). Survivor QOL was deteriorated (median total PAECC score: 5 (0, 11) points) although 75.76% of patients who survived showed good functional situation (GOS normal or mild dysfunction). An improvement in QOL scores between 1 and 3-4 years was observed (median PAECC score differences between 3-4 years and 1 year: - 1(- 4, 0) points). QOL score improved during this interval of time: 62.6% of patients. Change in QOL was related by multivariate analysis to admission cranial-computed tomography scan (Marshall's classification), age, and Injury Severity Score (ISS), with the biggest improvement seen in younger patients and with more severe ISS. Basic physiological activities were maintained in the majority of patients. Subjective aspects and working activities improved between 1 and 3-4 years but with a high proportion still impaired in these items after 3-4 years. CONCLUSIONS ICU patients with TBI after 1 year show improvement in QOL between 1 and 3-4 years, with the biggest improvement in QOL seen in younger patients and in those with more severe ISS.
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Affiliation(s)
| | | | | | | | - Eduardo Aguilar-Alonso
- Intensive Care Medicine, Hospital Infanta Margarita, Avenida de Gongora s/n., 14940, Cabra, Cordoba, Spain.
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Quality of Life and Related Factors Among Patients Discharged from Critical Care Units. ACTA ACUST UNITED AC 2017. [DOI: 10.5812/ccn.62148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rivera-Lopez R, Gutierrez-Rodriguez R, Lopez-Caler C, Aguilar-Alonso E, Castillo-Lorente E, Garcia-Delgado M, Arias-Verdu MD, Iglesias-Posadilla D, Barrueco-Francioni JE, Quesada-Garcia G, Rivera-Fernandez R. Relationship between functional status prior to onset of critical illness and mortality: a prospective multicentre cohort study. Anaesth Intensive Care 2017; 45:351-358. [PMID: 28486893 DOI: 10.1177/0310057x1704500310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This prospective study aimed to assess the association between prior functional status and hospital mortality for patients admitted to four intensive care units in Spain between 2006 and 2012. Prior functional status was classified into three groups, using a modification of the Glasgow Outcome Scale (GOS), including group 1 with no limitations on activities of daily living; group 2 with some limitations but self-sufficient; and group 3 who were dependent on others for their activities of daily living. Of the 1,757 patients considered (mean Simplified Acute Physiology Score [SAPS] predicted mortality 14.8% and hospital mortality 13.7%), group 1 had the lowest observed hospital mortality (8.3%) compared to the SAPS 3 predicted mortality (11.6%). The observed mortality for group 2 (20.6%) and group 3 (27.4%) were both higher than predicted (19.2% and 21.2% respectively; odds ratio [OR] 1.97, 95% confidence interval [CI] 1.38-2.82 for group 2 and OR 2.90, 95% CI 1.78-4.72 for group 3 compared to group 1). Combining prior functional status and Sequential Organ Failure Assessment (SOFA) score with SAPS 3 further improved the ability of the SAPS 3 scores in predicting hospital mortality (area under the receiver operating characteristic curve 0.85 [95% CI 0.82-0.88] versus 0.84 [95% CI 0.81-0.87] respectively). In summary, patients with limited functional status prior to ICU admission had a higher risk of observed hospital mortality than predicted. Assessing prior functional status using a relatively simple questionnaire, such as a modified GOS, has the potential to improve the accuracy of existing prognostic models.
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Affiliation(s)
- R Rivera-Lopez
- Cardiologist, Cardiology Care Unit, Hospital Virgen de las Nieves, Granada, Spain
| | | | - C Lopez-Caler
- Intensivist, Intensivist, Intensive Care Unit, Hospital Regional Carlos Haya, Málaga, Spain
| | - E Aguilar-Alonso
- Intensivist, Intensive Care Unit, Hospital Infanta Margarita, Andalusian Health Service, Cordoba, Spain
| | - E Castillo-Lorente
- Intensivist, Intensive Care Unit, Hospital Neurotraumatológico, Jaén, Spain
| | - M Garcia-Delgado
- Intensivist, Intensive Care Unit, Hospital Virgen de las Nieves, Granada, Spain
| | - M D Arias-Verdu
- Intensivist, Intensive Care Unit, Hospital Regional Carlos Haya, Málaga, Spain
| | | | | | - G Quesada-Garcia
- Intensivist, Intensive Care Unit, Hospital Regional Carlos Haya, Málaga, Spain
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Mahesh PKB, Gunathunga MW, Jayasinghe S, Arnold SM, Haniffa R, De Silva AP. Pre-event quality of life and its influence on the post-event quality of life among patients with ST elevation and non-ST elevation myocardial infarctions of a premier province of Sri Lanka. Health Qual Life Outcomes 2017; 15:154. [PMID: 28764724 PMCID: PMC5540486 DOI: 10.1186/s12955-017-0730-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pre-event Quality of Life (QOL) reflects the true social circumstances in which people live prior to the onset of myocardial infarctions. It is believed to be a predictor of the post-event QOL. The aim of this study was to describe the pre-event QOL and its influence on the post-event Quality of Life among patients with ST elevation (STEMI) and Non-ST elevation myocardial infarctions (NSTEMI) using Short Form-36 (SF-36), a generic QOL tool with 8 domains. Documented literature is rare in this regard in Sri Lanka, which is a lower-middle-income country. METHODS A cross-sectional study with a 28-day post-discharge follow-up was carried out in 13 hospitals. Three hundred and forty-four patients who were diagnosed with STEMI or NSTEMI were recruited during the hospital stay. The pre-event QOL was measured using an interviewer-administered questionnaire which included the SF-36 QOL tool and medical details. Follow-up QOL was gathered using a questionnaire that was filled and posted back by participants. Of the recruited sample, 235 responded for the follow-up component. Analysis was conducted for associations between pre- and post-discharge QOL. Furthermore, comparisons were made between the STEMI and NSTEMI groups. Mann Whiney U test, Wilcoxon signed rank test and chi square test were used in the analysis. RESULTS The post-event QOL was lower in seven out of eight domains than the pre-event QOL (p < 0.05). The NSTEMI group had more risk factors and a significantly lower pre-event QOL for seven domains (p < 0.05), when compared to the STEMI group. For seven domains, the post-discharge QOL was not significantly different (p > 0.05) between the STEMI and NSTEMI groups. Post-discharge general-health QOL domain score was higher than the pre-MI score (p = 0.028) and was higher in the STEMI group compared to the NSTEMI group (p = 0.042). Regression analysis showed a significant beta coefficient between pre- and post-QOL for five domains in STEMI and for all domains in NSTEMI groups when adjusted for the disease severity. The R square values ranged from 12.3 to 62.3% for STEMI and 7.3 to 64.8% for NSTEMI. CONCLUSIONS Pre-event QOL is lower in the NSTEMI group compared to the STEMI group. Patients do not regain the previous QOL within one month post-discharge. Post-discharge QOL can be predicted by the pre-event QOL for most domains.
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Affiliation(s)
- P. K. B. Mahesh
- Office of Regional Director of Health Services, Colombo, Sri Lanka
| | - M. W. Gunathunga
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Saroj Jayasinghe
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - S. M. Arnold
- Office of Regional Director of Health Services, Colombo, Sri Lanka
| | - R. Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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Prieto-Palomino MA, Curiel-Balsera E, Arias-Verdú MD, Der Kroft MDV, Muñoz-López A, Fernández-Ortega JF, Quesada-García G, Sanchez-Cantalejo E, Rivera-Fernández R. Relationship between quality-of-life after 1-year follow-up and severity of traumatic brain injury assessed by computerized tomography. Brain Inj 2016; 30:441-451. [PMID: 26963562 DOI: 10.3109/02699052.2016.1141434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This paper studies the relationship between computed tomography (CT) scan on admission, according to Marshall's tomographic classification, and quality-of-life (QoL) after 1 year in patients admitted to the Intensive Care Unit (ICU) with traumatic brain injury (TBI). METHODS This study used validated scales including the Glasgow Outcome Scale and the PAECC (Project for the Epidemiologic Analysis of Critical Care Patients) QoL questionnaire. RESULTS We enrolled 531 patients. After 1 year, 171 patients (32.2%) had died (missing data = 6.6%). Good recovery was seen in 22.7% of the patients, while 20% presented moderate disability. The PAECC score after 1 year was 9.43 ± 8.72 points (high deterioration). Patients with diffuse injury I had a mean of 5.08 points vs 7.82 in those with diffuse injury II, 11.76 in those with diffuse injury III and 19.29 in those with diffuse injury IV (p < 0.001). Multivariate analysis found that QoL after 1 year was associated with CT Marshall classification, depth of coma, age, length of stay, spinal injury and tracheostomy. CONCLUSIONS Patients with TBI had a high mortality rate 1 year after admission, deterioration in QoL and significant impairment of functional status, although more than 40% were normal or self-sufficient. QoL after 1 year was strongly related to cranial CT findings on admission.
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Affiliation(s)
| | | | | | | | - Alfonso Muñoz-López
- a IBIMA, Intensive Care Unit , Hospital Regional Universitario , Málaga , Spain
| | | | | | - Emilio Sanchez-Cantalejo
- c Escuela Andaluza de Salud Pública , Instituto de Investigación Biosanitaria de Granada (Granada.ibs) , CIBERESP, Madrid , Spain
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Health-Related Quality of Life in Australasian Survivors of H1N1 Influenza Undergoing Mechanical Ventilation. A Multicenter Cohort Study. Ann Am Thorac Soc 2015; 12:895-903. [DOI: 10.1513/annalsats.201412-568oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
OBJECTIVE Mortality on medical intensive care units (ICU) is approximately 25%. It is associated with age, severity of illness, and comorbidities. Preexisting depression is a risk factor for worse outcome in many diseases. The impact of depression on outcome of ICU patients has not been investigated. We assessed a possible association between mortality and preexisting depressive mood at the time of ICU admission. The primary end point was 28-day mortality. METHODS This single-center cohort study was conducted in a tertiary medical ICU. Two hundred patients were evaluated for preexisting depressive mood at ICU admission, determined by Hospital Anxiety and Depression Scale (HADS) score ≥8 in the depression dimension in patients with appropriate cognitive function. Patients with insufficient cognitive function were assessed using observer rating by next of kin by Hammond scale (cutoff ≥4) and/or a modified version of the Hospital Anxiety and Depression Scale for observer rating (cutoff ≥10). RESULTS In total, 66 (33%) of 200 patients were classified with preexisting depressive mood. Forty-nine (24.5%) of 200 patients had died by day 28. Of these, 23 (47%) had preexisting depressive mood as compared with 43 of 151 (29%) 28-day survivors (p = .017). Multiple logistic regression analysis revealed that preexisting depressive mood at the time of ICU admission is an independent risk factor for 28-day (odds ratio = 2.2, 95% confidence interval = 1.08-4.5, p = .030) and in-hospital mortality (median time till death = 20.5 [2-186] days, odds ratio = 2.58, 95% confidence interval = 1.31-5.1, p = .006). CONCLUSION Preexisting depressive mood might be an independent risk factor for 28-day mortality in medical ICU patients. This could have diagnostic and therapeutic implications for critically ill patients.
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Kiernan F. Quality of life: changing the face of outcome measurements in critical care. Anaesthesia 2014; 69:1073-7. [PMID: 25204234 DOI: 10.1111/anae.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F Kiernan
- Royal College of Surgeons of Ireland, Dublin, Ireland.
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Bukan RI, Møller AM, Henning MAS, Mortensen KB, Klausen TW, Waldau T. Preadmission quality of life can predict mortality in intensive care unit--a prospective cohort study. J Crit Care 2014; 29:942-7. [PMID: 25060638 DOI: 10.1016/j.jcrc.2014.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/06/2014] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE We sought to investigate whether preadmission quality of life could act as a predictor of mortality among patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS This is a prospective observational study of all patients above the age of 18 years admitted to the ICU with a length of stay longer than 24 hours. Short form 36 (SF-36) and Acute Physiology and Chronic Health Evaluation II (APACHE II) were used. Mortality was assessed during ICU admission, 30, and 90 days hereafter. RESULTS We included 318 patients. No patients were lost to follow-up. Using the physical component summary of short form 12 (SF-12) as a predictor of ICU mortality, the area under the curve (0.70; confidence interval, 0.62-0.77) was comparable with that of APACHE II (0.74; confidence interval, 0.67-0.82). The difference between SF-12 and SF-36 was nonsignificant. CONCLUSIONS Preadmission quality of life, assessed by SF-36 and SF-12, is as good at predicting ICU, 30-, and 90-day mortality as APACHE II in patients admitted to the ICU for longer than 24 hours. This indicates that estimated preadmission quality of life, potentially available in the pre-ICU setting, could aid decision making regarding ICU admission and deserves more attention by those caring for critically ill patients.
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Affiliation(s)
- Ramin I Bukan
- Herlev University Hospital, Department of Anesthesiology I, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Ann M Møller
- Herlev University Hospital, Department of Anesthesiology I, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Mattias A S Henning
- Herlev University Hospital, Department of Anesthesiology I, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Katrine B Mortensen
- University of Copenhagen, Faculty of Health and Medical Science, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - Tobias W Klausen
- Herlev University Hospital, Clinical Research Department of Hematology, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Tina Waldau
- Herlev University Hospital, Department of Anesthesiology I, Herlev Ringvej 75, 2730 Herlev, Denmark.
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Tereran NP, Zanei SSV, Whitaker IY. Quality of life before admission to the intensive care unit. Rev Bras Ter Intensiva 2013; 24:341-6. [PMID: 23917930 PMCID: PMC4031806 DOI: 10.1590/s0103-507x2012000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022] Open
Abstract
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.
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Schenk P, Warszawska J, Fuhrmann V, König F, Madl C, Ratheiser K. Health-related quality of life of long-term survivors of intensive care: changes after intensive care treatment. Experience of an Austrian intensive care unit. Wien Klin Wochenschr 2012; 124:624-32. [PMID: 22875391 DOI: 10.1007/s00508-012-0224-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/09/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study was to determine if health-related quality of life of long-term survivors changes 24 months after intensive care treatment compared to the quality of life before admission. METHODS From 281 patients treated at the ICU in 2001, 132 survivors were contacted by phone on average 24 months after discharge. Fernandez questionnaire was used to assess preadmission quality of life prospectively and postdischarge quality of life, retrospectively. In addition, age, sex, admission diagnosis, ICU length of stay, presence of organ failure, and necessity of mechanical ventilation were determined. RESULTS In the 101 ICU survivors who responded to the questionnaire, the total score of quality of life did not change significantly over time (5.48 ± 5.3 before admission vs. 5.6 ± 5.8 at follow-up; p = 0.9). Similarly, the performance of normal daily activities did not alter (3.0 ± 3.5 vs. 3.39 ± 3.6; p = 0,3). In contrast, the ability to perform basic physiological activities worsened significantly (0.39 ± 0.76 vs. 0.76 ± 1.52; p = 0.037), whereas the emotional state improved significantly after intensive care treatment (2.08 ± 1.78 vs. 1.46 ± 1.56, p = 0.003). In a stepwise multiple regression analysis the total score of quality of life before admission was the only variable which influenced the quality of life 2 years after ICU-stay. CONCLUSIONS In the interviewed population the total score of health-related quality of life did not change after intensive care treatment. Surprisingly, emotional state improved significantly although physical performance decreased. Quality of life after ICU discharge was predominantly influenced by preadmission quality of life. However, these results are not reflective of all ICU survivors.
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Affiliation(s)
- Peter Schenk
- Department of Pulmonology, Landesklinikum Thermenregion Hochegg, Hocheggerstrasse 88, 2840, Grimmenstein, Austria.
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Associations between the use of critical care procedures and change in functional status at discharge. J Intensive Care Med 2012; 28:296-306. [PMID: 22777898 DOI: 10.1177/0885066612453121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Quality improvement initiatives in intensive care units (ICUs) have increased survival rates. Changes in functional status following ICU care have been studied, but results are inconclusive because of insufficient consideration of the combinations of critical care procedures used. Using the Japanese administrative database including the Barthel Index (BI) at admission and discharge, we measured the changes in functional status among the adult patients and determined whether longer ICU stay or use of various critical care procedures was associated with functional deterioration. Of the 12 502 528 patients admitted to 1206 hospitals over 5 consecutive years from 2006, we analyzed data from patients aged 15 years or older who survived ICU admission in 320 hospitals. Critical care procedures evaluated were ventilation, blood purification (hemodialysis, hemodiafiltration, or hemadsorption), and cardiac support devices (intra-aortic balloon pump or percutaneous cardiopulmonary support system). Functional outcomes were determined by the difference between BI at admission and at discharge and were divided into improvement, no change, or deterioration. We compared patient characteristics, principal diagnosis, comorbidities, timing of surgical procedure, complications, days in ICU, and use of critical care procedures among the 3 categories. Associations between critical care procedures and functional deterioration were identified using multivariate analysis. Of 234 209 patients with complete BI information, 7137 (3.1%) received blood purification, 27 100 (11.7%) received ventilation, 2888 (1.2%) received blood purification and ventilation, 5613 (2.4%) received a cardiac support device, 247 (0.1%) received a cardiac support device and blood purification, 10 444 (4.5%) received a cardiac support device and ventilation, and 1110 (0.5%) received a cardiac support device, ventilation, and blood purification. Longer use of blood purification or ventilation and a longer ICU stay were associated with functional deterioration. Intensivists should be aware of the effects of critical care procedures on functional deterioration and advance the appropriate use of functional support according to each patient's condition.
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Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
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Muñoz Camargo J, Martín Tercero M, Nuñez Lopez M, Espadas Maeso M, Pérez Fernandez-Infantes S, Cinjordis Valverde P, Leon Rodríguez A, Moreno Ortiz J, Huertas Díaz M. Limitación del esfuerzo terapéutico. Opinión de los profesionales. ENFERMERIA INTENSIVA 2012; 23:104-14. [DOI: 10.1016/j.enfi.2011.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/27/2011] [Accepted: 12/07/2011] [Indexed: 11/26/2022]
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Wilcox ME, Herridge MS. Lung function and quality of life in survivors of the acute respiratory distress syndrome (ARDS). Presse Med 2011; 40:e595-603. [PMID: 22078086 DOI: 10.1016/j.lpm.2011.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/29/2011] [Indexed: 11/26/2022] Open
Abstract
Recent studies have begun to describe the long-term outcomes of acute respiratory distress syndrome (ARDS) survivors. These patients experience a number of physical, mental and psychological morbidities that significantly impair their health-related quality of life (HRQL). The trajectory of pulmonary recovery in survivors of ARDS, as it relates to lung function, structure and health-related quality of life (HRQL), is predictable and often persists years after hospital discharge. True pulmonary parenchymal morbidity is uncommon and when present, persistent restrictive disease is likely related to diaphragmatic weakness with a mild reduction in diffusion capacity (DLCO). Future research should focus on identifying patients at risk for long-term functional limitations and the design of rehabilitation interventions tailored to individual patient needs.
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Affiliation(s)
- M Elizabeth Wilcox
- University of Toronto, Toronto Western Hospital, Division of Pulmonary and Critical Care Medicine, Toronto, Ontario, Canada.
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Skinner EH, Warrillow S, Denehy L. Health-related quality of life in Australian survivors of critical illness. Crit Care Med 2011; 39:1896-1905. [PMID: 21532478 DOI: 10.1097/ccm.0b013e31821b8421] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To document health-related quality of life of an Australian sample of intensive care unit survivors 6 months after intensive care unit discharge and compare this with preadmission health-related quality of life, health-related quality of life of national population norms, and international samples of intensive care unit survivors. DESIGN Prospective observational single-center study. SETTING Eighteen-bed medical-surgical tertiary intensive care unit of an Australian metropolitan hospital. PATIENTS Of the 122 eligible patients, 100 were recruited (intensive care unit length of stay >48 hrs, age >18 yrs, not imminently at risk of death) and the final sample comprised 67 patients, age (median [interquartile range], 61 yrs [49-73 yrs]), 60% male admitted to the intensive care unit for a median [interquartile range] 101 hrs (68-149 hrs). Normative age- and sex-matched Australian Short-Form 36 data from the Australian Bureau of Statistics, selected international cohorts of intensive care unit survivors, and their respective national age-matched normative data were included for comparison. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Sixty-seven participants provided responses to questions rating health-related quality of life (Australian Short-Form 36) at preadmission (on admission to the intensive care unit or through retrospective recall as soon as able) and 6 months after intensive care unit discharge. Ten additional participants were unable to provide study data without proxy input and were excluded from analysis. Participants reported clinically meaningful improvements in bodily pain (p = .001), social functioning (p = .03), role-emotional domains of the Short-Form 36 (p = .04), and mental component summary score (p = .01) at 6 months after intensive care unit discharge, mostly attributable to the patients undergoing cardiac surgery, whereas remaining Short-Form 36 domains showed no difference between preadmission and 6 months (p > .05). Participants reported clinically meaningful decrements in preadmission Short-Form 36 data compared with the Australian normative population with role-physical (p < .001) and physical functioning (p < .001) most affected at follow-up. Health-related quality of life in this sample was comparable with international samples of intensive care unit survivors. CONCLUSIONS Although the majority of health-related quality of life domains did not differ between preadmission and 6-month follow-up, participants reported significant and clinically meaningful improvements in pain and mental health at follow-up. Critical illness survivors' health-related quality of life remained within 1 sd of Australian norms at follow-up and physical function health-related quality of life was most affected. Health-related quality of life in these Australian survivors of the intensive care unit was comparable with international survivors 6 months after intensive care unit admission.
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Affiliation(s)
- Elizabeth H Skinner
- Department of Physiotherapy and Department of Intensive Care, Monash Medical Centre, Southern Health, Clayton, Victoria, Australia.
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Dinglas VD, Gellar J, Colantuoni E, Stan VA, Mendez-Tellez PA, Pronovost PJ, Needham DM. Does intensive care unit severity of illness influence recall of baseline physical function? J Crit Care 2011; 26:634.e1-7. [PMID: 21737233 DOI: 10.1016/j.jcrc.2011.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 04/19/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study is to evaluate if severity of illness in the intensive care unit influences patients' retrospective recall of their baseline physical function from before hospital admission. MATERIALS AND METHODS This is a prospective cohort study of 193 acute lung injury survivors who, before hospital discharge, retrospectively reported their prehospitalization physical function using the Short Form 36 quality of life survey. RESULTS Four measures were used to evaluate intensive care unit (ICU) severity of illness: (1) Acute Physiology and Chronic Health Evaluation II Acute Physiologic Score at ICU admission, (2) Lung Injury Score at acute lung injury diagnosis, (3) Sequential Organ Failure Assessment score at study enrollment, and (4) maximum daily Sequential Organ Failure Assessment score during the entire ICU stay. In multivariable linear regression analysis, no measure of severity of illness was associated with prehospitalization physical function. Education level significantly modified the relationship between ICU severity of illness and baseline physical function with lower educational attainment having a stronger association with baseline physical function. CONCLUSION Intensive care unit severity of illness was not associated with patients' retrospectively recalled baseline physical function. Patients with a lower level of education may be more influenced by ICU severity of illness, but the magnitude of this effect may not be clinically meaningful.
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Affiliation(s)
- Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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Székely A, Nussmeier NA, Miao Y, Huang K, Levin J, Feierfeil H, Mangano DT. A multinational study of the influence of health-related quality of life on in-hospital outcome after coronary artery bypass graft surgery. Am Heart J 2011; 161:1179-1185.e2. [PMID: 21641366 DOI: 10.1016/j.ahj.2011.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The effect of health-related quality of life on in-hospital outcomes after coronary artery bypass grafting surgery has not been investigated in international multicenter studies. We hypothesized that poor preoperative health status is associated with mortality and length of hospital stay. METHODS In the Multicenter Study of Perioperative Ischemia Epidemiology II, preoperative Short-Form 12, Mental Component Summary (MCS), and Physical Component Summary (PCS) scores were obtained prospectively from 4,811 patients (3,834 men, 977 women) undergoing coronary artery bypass grafting surgery at 72 centers in 17 countries. Primary outcome measures were in-hospital mortality and prolonged (>14 days) length of hospital stay. RESULTS One hundred fifty-one patients (3.1%) died. After adjustment for regional differences, a 10-point reduction in MCS score was associated with higher mortality risk (odds ratio [OR] 1.17, 95% CI 1.004-1.37, P = .04) and prolonged hospital stay (OR 1.11, 95% CI 1.01-1.21, P = .03). The preoperative PCS score was not associated with mortality risk but significantly predicted prolonged length of hospital stay (OR 1.20, 95% CI 1.09-1.33, P < .001). There was no significant interaction between gender and either the MCS or the PCS score. DISCUSSION The preoperative PCS predicted prolonged postoperative hospital stay, whereas the preoperative MCS score was an independent predictor of both prolonged length of hospital stay and mortality. Preoperative assessment of health-related quality of life factors with the Short-Form 12 might be a useful tool for risk stratification and planning for hospital discharge and rehabilitation.
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Patient and healthcare professional factors influencing end-of-life decision-making during critical illness: A systematic review*. Crit Care Med 2011; 39:1174-89. [DOI: 10.1097/ccm.0b013e31820eacf2] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abizanda Campos R, Altaba Tena S, Belenguer Muncharaz A, Más Font S, Ferrándiz Sellés A, Mateu Campos L, de León Belmar J. [Study of post-ICU mortality during 4 years (2006-2009). Analysis of the factors related to death in the ward after discharge from the ICU]. Med Intensiva 2011; 35:150-6. [PMID: 21356566 DOI: 10.1016/j.medin.2010.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 11/18/2010] [Accepted: 12/18/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To detect possible reasons for mortality of critical patients transferred from the ICU to the hospital wards and to analyze the possible attributable causes for such mortality. DESIGN An observational study of prospectively collected data, analyzed retrospectively. POPULATION Cohort analysis of 5328 with consecutive admissions to our ICU, whose evolution was followed up to hospital discharge or death. PERIOD From January 2006 to December 2009. METHOD An analysis was made of differential significance of epidemiological, clinical-care, death risk estimate, coincidence between ICU admissions reasons and causes of death after ICU discharge, as well as limitation of health care effort incidence. Inappropriate ICU discharge was considered to exist if the death occurred during the first 48 hours after ICU transfer, without limitation of care effort. RESULTS A total of 907 patients died (SMR=0.9; 95% CI, 0.87-0.93), 202 of whom died after ICU discharge (3.8% of total sample and 22.3% of all deceased patients), ward length of stay being 12.4±17.9 days. No significant differences were found between deaths in the ICU or post-ICU deaths regarding infective complications appearing after admission to the ICU. Greater mortality was also not found in those re-admitted to the ICU after having been transferred to the ward. It was verified that the cause of death in the ward did not significantly coincide with the cause of admission to the ICU. DISCUSSION Some mortality after ICU discharge is to be expected. Our data do not allow us to attribute this mortality rate to care deficiencies (inappropriate ICU discharges or deceased care in the wards). The reasons for this mortality have a varied and variable explanation. It mostly corresponds to an evolution of the patients differing from that expected when they were discharged from ICU.
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Affiliation(s)
- R Abizanda Campos
- Servicio de Medicina Intensiva, Hospital Universitario Asociado General de Castellón, Castellón, España.
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Abstract
OBJECTIVES To evaluate quality of life at least 12 months after discharge from the intensive care unit of adult critically ill patients, to evaluate the methodology used to assess long-term quality of life, and to give an overview of factors influencing quality of life. DATA SOURCES EMBASE-PubMed, MEDLINE (OVID), SCI/Web of Science, the Cochrane Library, Google Scholar, and personal files. DATA EXTRACTION Data extraction was performed independently and cross-checked by two reviewers using a predefined data extraction form. Eligible studies were published between 1999 and 2009 and assessed quality of life ≥12 months after intensive care unit discharge by means of the Medical Outcomes Study 36-Item Short Form Health Survey, the RAND 36-Item Health Survey, EuroQol-5D, and/or the Nottingham Health Profile in adult intensive care unit patients. DATA SYNTHESIS Fifty-three articles (10 multicenters) were included, with the majority of studies performed in Europe (68%). The Medical Outcomes Study 36-Item Short Form Health Survey was used in 55%, and the EuroQol-5D, the Nottingham Health Profile, the RAND 36-Item Health Survey, or a combination was used in 21%, 9%, 8%, or 8%, respectively. A response rate of ≥80% was attained in 26 studies (49%). Critically ill patients had a lower quality of life than an age- and gender-matched population, but quality of life tended to improve over years. The worst reductions in quality of life were seen in cases of severe acute respiratory distress syndrome, prolonged mechanical ventilation, severe trauma, and severe sepsis. Study quality criteria, defined as a baseline quality of life assessment, the absence of major exclusion criteria, a description of nonresponders, and a comparison with a reference population were met in only four studies (8%). Results concerning the influence of severity of illness, comorbidity, preadmission quality of life, age, gender, or acquired complications were conflicting. CONCLUSIONS Quality of life differed on diagnostic category but, overall, critically ill patients had a lower quality of life than an age- and gender-matched population. A minority of studies met the predefined methodologic quality criteria. Results concerning the influence of the patients' characteristics and illnesses on long-term quality of life were conflicting.
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Limitación del tratamiento en una unidad de cuidados intensivos. Med Clin (Barc) 2010; 135:573-4; author reply 574. [DOI: 10.1016/j.medcli.2009.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/08/2009] [Indexed: 11/19/2022]
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Fernandez R, Serrano JM, Umaran I, Abizanda R, Carrillo A, Lopez-Pueyo MJ, Rascado P, Balerdi B, Suberviola B, Hernandez G. Ward mortality after ICU discharge: a multicenter validation of the Sabadell score. Intensive Care Med 2010; 36:1196-201. [PMID: 20221748 DOI: 10.1007/s00134-010-1825-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 01/21/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tools for predicting post-ICU patients' outcomes are scarce. A single-center study showed that the Sabadell score classified patients into four groups with clear-cut differences in ward mortality. OBJECTIVE AND DESIGN To validate the Sabadell score using a prospective multicenter approach. SETTING Thirty-one ICUs in Spain. PATIENTS AND METHODS All patients admitted in the 3-month study period. We recorded variables at ICU admission (age, sex, severity of illness, and do-not-resuscitate orders), during the ICU stay (ICU-specific treatments, ICU-acquired infection, and acute renal failure), and at ICU discharge (Sabadell score). Statistical analyses included one-way ANOVA and multiple regression analysis with ward mortality as the dependent variable. RESULTS We admitted 4,132 patients (mean age 61.5 +/- 16.7 years) with mean predicted mortality of 23.8 +/- 22.7%; 545 patients (13%) died in the ICU and 3,587 (87%) were discharged to the ward. Overall ward mortality was 6.7%; ward mortality was 1.5% (36/2,422) in patients with score 0 (good prognosis), 9% (64/725) in patients with score 1 (long-term poor prognosis), 23% (79/341) in patients with score 2 (short-term poor prognosis), and 64% (63/99) in patients with score 3 (expected hospital death). Variables associated with ward mortality in the multivariate analysis were predicted risk of death (OR 1.016), ICU readmission (OR 5.9), Sabadell score 1 (OR 4.7), Sabadell score 2 (OR 15.7), and Sabadell score 3 (OR 107.2). CONCLUSION We confirm the ability of the Sabadell score at ICU discharge to define four groups of patients with very different likelihoods of hospital survival.
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Affiliation(s)
- Rafael Fernandez
- CIBER Enfermedades Respiratorias, ICU, Hospital Sant Joan de Deu, Fundació Althaia, Manresa, Spain.
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Health-related quality of life in critically ill patients: how to score and what is the clinical impact? Curr Opin Crit Care 2009; 15:425-30. [DOI: 10.1097/mcc.0b013e32833079e4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Iribarren-Diarasarri S, Aizpuru-Barandiaran F, Muñoz-Martínez T, Dudagoitia-Otaolea JL, Castañeda-Sáez A, Hernández-López M, Martínez-Alutiz S, Vinuesa-Lozano C, Aretxabala-Kortajarena N. [Variations in health-related quality of life in critical patients]. Med Intensiva 2009; 33:115-22. [PMID: 19406084 DOI: 10.1016/s0210-5691(09)70944-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the changes in the health-related quality of life (hRQOL) six months after discharge from the ICU and the conditions associated to them. DESIGN A prospective cohort study. SETTING 14 beds medical-surgical intensive care unit (ICU). PATIENTS A total of 247 patients admitted to our ICU for more than 24 hours with a follow-up of 6 months were study. Those admitted with acute coronary syndrome or for monitoring purposes were excluded. INTERVENTION A quality of life survey was conducted using the score developed by the PAEEC group (project of the epidemiological analysis of critical illness) to assess hRQOL before ICU admission and 6 months after discharge. RESULTS The hRQOL deteriorated, going from a median value of 3 to 6 (p < 0.001). The multivariate analysis showed less deterioration of hRQOL in patients with chronic health conditions registered on the APAChE-II score (regression coefficient [RC] = -1.4; 95% CI, -2.5 to -0.2; p < 0.02) and in those with a hRQOL > or = 10 points (RC = -4,4; 95% CI, -5.9 to -2.8; p < 0.001). There was more deterioration in polytraumatized patients (RC = 1.9; 95% CI, 0.6-3.3; p = 0.01) or with renal failure (RC = 3.9; 95% CI, 1.9-5.9; p < 0.001) or in those with a stay duration longer than 10 days (RC = 1.9; 95% CI, 0.6-3.2; p < 0.001). CONCLUSIONS Most patients experience deterioration of hRQOL. Patients with chronic diseases or with worst previous hRQOL who survive 6 months experience less deterioration of hRQOL than those who are polytraumatized or have renal failure or a longer ICU stay.
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Badia Castelló M, Trujillano Cabello J, Serviá Goixart L, March Llanes J, Rodríguez-Pozo A. [Changes in health-related quality of life after ICU according to diagnostic category. Comparison of two measurement instruments]. Med Intensiva 2009; 32:203-15. [PMID: 18570830 DOI: 10.1016/s0210-5691(08)70942-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Assessment of health related quality of life (HRQOL) before and 12 months after discharge from a mixed intensive care unit (ICU) according to diagnostic category and the relationship between both instruments. DESIGN Prospective observational study. SETTING The combined medical/surgical ICU in a secondary university hospital with 450 beds. PATIENTS Patients admitted to the ICU over an 18-month period. MAIN VARIABLES Variables on demography, diagnosis on admission, severity of acute illness score (APACHE II), length of stay, procedures, mortality and the HRQOL were collected using the Short Form SF-36 and EQ-5D questionnaires. Health status prior to admission was evaluated retrospectively. RESULTS Both questionnaires were answered by 189 patients. A significant deterioration in the quality of life was observed 12 months after ICU discharge. Head injury and neurological patients had worse HRQOL one year after discharge. Multiple trauma patients presented severe physical limitations and pain, but without significant differences on the emotional level. The EQ Visual Analogue Scale and the EQ Index score showed clinically relevant differences in these three groups. Respiratory patients are the only group in whom the HRQOL improved. Comparison between both measurement instruments showed a strong correlation on the physical functioning level, but a weaker correlation on the emotional functioning one. CONCLUSIONS HRQOL assessment of ICU patients must be done according to a diagnostic category. Both instruments (the EQ-5D and SF-36) are capable of detecting changes in HRQOL. Despite differences in structure and content, both measure similar aspects of quality of life.
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Affiliation(s)
- M Badia Castelló
- Servicio de Medicina Intensiva, Hospital Universitario Arnau de Vilanova, Lleida, España.
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Iribarren-Diarasarri S, Aizpuru-Barandiaran F, Muñoz-Martínez T, Loma-Osorio A, Hernández-López M, Ruiz-Zorrilla JM, Castillo-Arenal C, Dudagoitia-Otaolea JL, Martínez-Alutiz S, Vinuesa-Lozano C. Health-related quality of life as a prognostic factor of survival in critically ill patients. Intensive Care Med 2009; 35:833-9. [PMID: 19183948 DOI: 10.1007/s00134-009-1418-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 12/15/2008] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate whether health-related quality of life prior to admission into an intensive care unit (ICU) is a prognostic factor of hospital and 1 year mortality. DESIGN Prospective cohort study. SETTING Fourteen-bed medical-surgical ICU. PATIENTS A total of 377 patients admitted to the ICU for more than 24 h with 1-year follow-up after discharge from the hospital. INTERVENTION A health-related quality of life (HRQoL) survey was conducted, using the questionnaire developed by the "Project for the Epidemiological Analysis of Critical Care Patients", to assess patient's quality of life 1 month before ICU hospitalization. RESULTS Hospital mortality was independently associated with severity assessed by APACHE II, odds ratio (OR) 1.14 [95% confidence interval (CI) 1.08-1.2; P < 0.001], high workload assessed by Nine Equivalents of Nursing Manpower Score > 30 OR 3.6 (95% CI 1.4-9.0; P = 0.006), hospital length of stay prior to ICU admission of more than 2 days OR 2.6 (95% CI 1.3-5.4; P = 0.008), and bad quality of life prior to ICU admission assessed by a HRQoL score > or = 8 points OR 2.2 (95% CI 1.03-4.5; P = 0.04). Patients who scored > or =8 on the HRQoL survey presented a risk of demise 12 months after discharge almost twofold that of those who had good previous HRQoL (0-2 points), Hazard Ratio 1.9 (95% CI 1.3-2.8; P = 0.001). CONCLUSION Bad quality of life is associated with hospital mortality and survival 12 months after hospital discharge.
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Hofhuis JGM, Spronk PE, van Stel HF, Schrijvers AJP, Rommes JH, Bakker J. The Impact of Severe Sepsis on Health-Related Quality of Life: A Long-Term Follow-Up Study. Anesth Analg 2008; 107:1957-64. [DOI: 10.1213/ane.0b013e318187bbd8] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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de Rooij SEJA, Govers AC, Korevaar JC, Giesbers AW, Levi M, de Jonge E. Cognitive, functional, and quality-of-life outcomes of patients aged 80 and older who survived at least 1 year after planned or unplanned surgery or medical intensive care treatment. J Am Geriatr Soc 2008; 56:816-22. [PMID: 18384589 DOI: 10.1111/j.1532-5415.2008.01671.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate long-term cognitive, functional, and quality-of-life outcomes in very elderly survivors at least 1 year after planned or unplanned surgery or medical intensive care treatment. DESIGN Retrospective cohort study. SETTING General, 1,024-bed, tertiary university teaching hospital in The Netherlands. PARTICIPANTS Two hundred four survivors of a cohort of 578 patients admitted to the medical-surgical intensive care unit (ICU) between January 1997 and December 2002 and alive in December 2003. The majority of survivors underwent elective surgery. MEASUREMENTS From December 2003 until February 2004, data were collected from 190 patients and 169 relatives. The measures were: Informant Questionnaire on Cognitive Decline short form (IQCODE-SF) (cognition), modified Katz index of activities of daily living (ADLs) (functional status), and EuroQol (EQ-5D) (health-related quality of life). The patients themselves completed the modified Katz ADL index and EQ-5D forms; their caregivers completed the ADL caregiver version and IQCODE-SF. RESULTS The mean age at admission+/-standard deviation was 81.7+/-2.4, and the median time after discharge was 3.7 years (range 1-5.9 years). Of the ICU patients who had planned surgery, 57% survived, compared with 11% of the unplanned surgical admissions and 10% of the medical patients. Three-quarters (74.3%) of the patients who lived at home before ICU admission remained at home at follow-up. Eighty-three percent had no severe cognitive impairment, and 76% had no severe physical limitations (33% had moderate, 40% had mild, and 3% had no limitations). The perceived quality of life was similar to that of an age-matched general population. CONCLUSION Long-term survivors of ICU treatment received at the age of 80 and older showed fair-to-good cognitive and physical functioning and quality of life, although few patients who underwent unplanned surgery or who were admitted to the ICU for medical reasons survived.
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Affiliation(s)
- Sophia E J A de Rooij
- Department of Internal Medicine and Geriatrics, Academic Medical Center, Amsterdam, The Netherlands.
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Hofhuis JGM, Spronk PE, van Stel HF, Schrijvers AJP, Bakker J. Quality of life before intensive care unit admission is a predictor of survival. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:R78. [PMID: 17629906 PMCID: PMC2206516 DOI: 10.1186/cc5970] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 06/22/2007] [Accepted: 07/13/2007] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Predicting whether a critically ill patient will survive intensive care treatment remains difficult. The advantages of a validated strategy to identify those patients who will not benefit from intensive care unit (ICU) treatment are evident. Providing critical care treatment to patients who will ultimately die in the ICU is accompanied by an enormous emotional and physical burden for both patients and their relatives. The purpose of the present study was to examine whether health-related quality of life (HRQOL) before admission to the ICU can be used as a predictor of mortality. METHODS We conducted a prospective cohort study in a university-affiliated teaching hospital. Patients admitted to the ICU for longer than 48 hours were included. Close relatives completed the Short-form 36 (SF-36) within the first 48 hours of admission to assess pre-admission HRQOL of the patient. Mortality was evaluated from ICU admittance until 6 months after ICU discharge. Logistic regression and receiver operating characteristic analyses were used to assess the predictive value for mortality using five models: the first question of the SF-36 on general health (model A); HRQOL measured using the physical component score (PCS) and mental component score (MCS) of the SF-36 (model B); the Acute Physiology and Chronic Health Evaluation (APACHE) II score (an accepted mortality prediction model in ICU patients; model C); general health and APACHE II score (model D); and PCS, MCS and APACHE II score (model E). Classification tables were used to assess the sensitivity, specificity, positive and negative predictive values, and likelihood ratios. RESULTS A total of 451 patients were included within 48 hours of admission to the ICU. At 6 months of follow up, 159 patients had died and 40 patients were lost to follow up. When the general health item was used as an estimate of HRQOL, area under the curve for model A (0.719) was comparable to that of model C (0.721) and slightly better than that of model D (0.760). When PCS and MCS were used, the area under the curve for model B (0.736) was comparable to that of model C (0.721) and slightly better than that of model E (0.768). When using the general health item, the sensitivity and specificity in model D (sensitivity 0.52 and specificity 0.81) were similar to those in model A (0.45 and 0.80). Similar results were found when using the MCS and PCS. CONCLUSION This study shows that the pre-admission HRQOL measured with either the one-item general health question or the complete SF-36 is as good at predicting survival/mortality in ICU patients as the APACHE II score. The value of these measures in clinical practice is limited, although it seems sensible to incorporate assessment of HRQOL into the many variables considered when deciding whether a patient should be admitted to the ICU.
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Affiliation(s)
- José GM Hofhuis
- Department of Intensive Care Medicine, Gelre Hospitals (location Lukas), Albert Schweitzerlaan, 7334 DZ Apeldoorn, The Netherlands
- Department of Intensive Care Medicine, Erasmus Medical Centre, Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands
| | - Peter E Spronk
- Department of Intensive Care Medicine, Gelre Hospitals (location Lukas), Albert Schweitzerlaan, 7334 DZ Apeldoorn, The Netherlands
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
- Department of Medical Decision Making, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333 ZA, The Netherlands
| | - Augustinus JP Schrijvers
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Jan Bakker
- Department of Intensive Care Medicine, Erasmus Medical Centre, Gravendijkwal 230, Rotterdam, 3015 CE, The Netherlands
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Fildissis G, Zidianakis V, Tsigou E, Koulenti D, Katostaras T, Economou A, Baltopoulos G. Quality of life outcome of critical care survivors eighteen months after discharge from intensive care. Croat Med J 2008; 48:814-21. [PMID: 18074416 DOI: 10.3325/cmj.2007.6.814] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To assess the changes in health-related quality of life in patients discharged from the intensive care unit (ICU). METHODS At the General University ICU, Trauma Hospital in Athens, 242 patients were enrolled prospectively over a study period of 18 months. Out of these, 116 participants (47.9%) completed all survey components at 6, 12, and 18 months. We used Quality of Life-Spanish (QOL-SP) to assess the health-related quality of life. Patients or their relatives were interviewed on ICU admission and at 6, 12, and 18 months after discharge from the ICU. RESULTS Mean quality of life score of the patients increased from 2.9+/-4.8 (out of maximum 25 points) on ICU admission to 7.0+/-7.2 points at 6 months after discharge, and then decreased to 5.6+/-6.9 points at 18 months (P<0.001; Friedman Test). Multilinear regression analysis showed that the variables which had the strongest association with the quality of life on admission were age (P=0.002) and male sex (P=0.001), whereas age (P<0.001), length of ICU stay (P<0.001), and male sex (P=0.002) had the strongest association 18 months after discharge from the ICU. Survival rate was 66.9% at discharge from ICU and 61.6% at hospital discharge. There were 33% deaths in the ICU, 5.3% in the hospital, and 6.2% after ICU discharge. There were 7.4% patients lost to follow-up. CONCLUSIONS After discharge from the ICU, patients' quality of life was poor and showed an improvement at 18 months after discharge, but was still worse than on admission. Age, ICU length of stay, and male sex were the factors that had the strongest impact on the quality of life on admission and at 18 months after discharge from the ICU.
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Affiliation(s)
- George Fildissis
- Athens University, Faculty of Nursing, ICU at KAT General Hospital, Nikis 2, 14561, Kifissia, Athens, Greece.
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Abelha FJ, Santos CC, Barros H. Quality of life before surgical ICU admission. BMC Surg 2007; 7:23. [PMID: 17997828 PMCID: PMC2194661 DOI: 10.1186/1471-2482-7-23] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Accepted: 11/12/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Examining the quality of life (QOL) of patients before ICU admission will allow outcome variables to be compared and analyzed in relation to it. The objective of this study was to analyze QOL of patients before admission to a surgical ICU and to study its relationship to outcome and to the baseline characteristics of the patients. METHODS All adult patients consecutively admitted to the surgical ICU between November 2004 and April 2005, who underwent non-cardiac surgery, were enrolled in this observational and prospective study. The following patient characteristics were recorded: age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, length of stay (LOS), in ICU and in hospital, mortality, Simplified Acute Physiology Score II (SAPS), history of co-morbidities and quality of life survey score (QOLSS). The relationships between QOLSS and ICU variables and outcome were evaluated. The relationship between the total QOLSS and each variable or outcome was assessed by multiple linear regression. RESULTS One hundred eighty seven patients completed the study. The preadmission QOLSS of the patients studied was 4.43 +/- 4.90; 28% of patients had a normal quality of life (0 points), 38% had between 1 and 5 points (considered mild deterioration), 21% had between 6 and 10 points (moderate deterioration), 10% had between 11 and 15 points (considered major deterioration) and 3% had more than 15 points (severe limitation of quality of life). A worse preadmission QOLSS was associated with higher SAPS II scores, with older patients (age> 65 years) and with ASA physical status (ASA III/IV). Total QOLSS was significantly worse in elderly patients and in patients with co-morbidities and in patients more severely ill at ICU admission. Patients who died in the ICU and in hospital had worse QOLSS scores compared to those who survived. However, no statistical differences in QOLSS were found in relation to longer ICU stays (ICU LOS). CONCLUSION Preadmission QOL correlates with age and severity of illness. Patients with co-morbidities and those who died during ICU or hospital stay had worse QOLSS scores.
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Affiliation(s)
- Fernando J Abelha
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal.
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Abelha FJ, Santos CC, Maia PC, Castro MA, Barros H. Quality of life after stay in surgical intensive care unit. BMC Anesthesiol 2007; 7:8. [PMID: 17650325 PMCID: PMC1949812 DOI: 10.1186/1471-2253-7-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 07/24/2007] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL) six months after discharge from an Intensive Care Unit (ICU), and to study its determinants. METHODS All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS), type and magnitude of surgical procedure, ICU and hospital length of stay (LOS), mortality and Simplified Acute Physiology Score II (SAPS II). Six months after discharge, a Short Form-36 questionnaire (SF-36) and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. RESULTS Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV), had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01-1.11, p = 0,016). Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI) and personal ADL (ADLP). ASA-PS (OR 3.00, 95%CI 1.31-6.87, p = 0.009) and age (OR 2.36, 95%CI, 1.04-5.34, p = 0.04) were associated with dependency in ADLI. For ADLP, only ASA-PS (OR 4.58, 95%CI, 1.68-12.46, p = 0.003) was associated with higher dependency. CONCLUSION ASA-PS, age, type of surgery, ICU LOS and SAPS II could be seen as determinants of HRQOL.
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Affiliation(s)
- Fernando J Abelha
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Cristina C Santos
- Biostatistics and Medical Informatics Department, University of Porto Medical School, Porto, Portugal
| | - Paula C Maia
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Maria A Castro
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Henrique Barros
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal
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Iribarren-Diarasarri S, Latorre-García K, Muñoz-Martínez T, Poveda-Hernández Y, Dudagoitia-Otaolea JL, Martínez-Alutiz S, Castillo-Arenal C, Ruiz-Zorrilla JM, Hernández-López M. [Limitation of therapeutic effort after ICU admission. Analysis of related factors]. Med Intensiva 2007; 31:68-72. [PMID: 17433184 DOI: 10.1016/s0210-5691(07)74778-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the limitation of therapeutic effort (LTE) in our Intensive Care Unit (ICU) and the variables associated with that decision. DESIGN Prospective cohort study with a follow up of one year after discharge. SETTING ICU of a second level hospital. PATIENTS Four hundred and nine patients admitted during a two-year period. MAIN VARIABLES APACHE II, NEMS, SOFA, quality of life (PAEEC) and mortality. RESULTS LTE was performed in 49 (12%) patients. This decision was made by general agreement among the care team in 88% of cases and with the family in 73.5%. It was made on day 8 (4-20) with a SOFA score of 9 (4-13). Mortality in the LTE group was 69.4% in ICU, 92% in hospital, and 96% at 6 and 12 months. A logistic regression model showed that the variables associated with LTE were the following: NEMS score >or=30.7 (OR 12; 95% CI 3.7-39, p < 0.001), NEMS 26.6-30.6 (OR 8; 95% CI 2.5-25.6, p = 0.001), APACHE II > 30 (OR 7.6; 95% CI 2-29, p = 0.003), quality of life >or= 7 (OR 4.2; 95% CI 1.1-15, p = 0.03), age >or= 80 (OR 3.7, 95% CI 1.4-9.5, p = 0.007) and medical patient condition (OR 3.5; 95% CI 1.5-8, p = 0.003). CONCLUSIONS LTE is a common practice and is usually performed among the care team and the patient's surrogates. The main variables associated with LSC are those related to the severity of illness, previous quality of life, medical disease and patient's age.
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Fernandez R, Baigorri F, Navarro G, Artigas A. A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 10:R179. [PMID: 17192174 PMCID: PMC1794495 DOI: 10.1186/cc5136] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 11/15/2006] [Accepted: 12/27/2006] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Mortality in the ward after an intensive care unit (ICU) stay is considered a quality parameter, and is described as a source of avoidable mortality. Additionally, the attending intensivist frequently anticipates fatal outcome after ICU discharge. Our objective was to test the ability of a new score to stratify patients according to ward mortality after ICU discharge. METHODS A prospective cohort study was performed in the general ICU of a university-affiliated hospital. In 2003 and 2004 we prospectively recorded the attending intensivist's subjective prognosis at ICU discharge about the hospital outcome for each patient admitted to the ICU (the Sabadell score), which was later compared with the real hospital outcome. RESULTS We studied 1,521 patients with a mean age of 60.2 +/- 17.8 years. The median (25-75% percentile) ICU stay was five (three to nine) days. The ICU mortality was 23.8%, with 1,156 patients being discharged to the ward. Post-ICU ward mortality was 9.6%, mainly observed in patients with a Sabadell score of 3 (81.3%) or a score of 2 (41.1%), whereas lower mortality was observed in patients scoring 1 (17.2%) and scoring 0 (1.7%). Multivariate analysis selected age and the Sabadell score as the only variables associated with ward mortality, with an area under the receiver operating curve of 0.88 (95% CI 0.84-0.93) for the Sabadell score. CONCLUSION The Sabadell score at ICU discharge works effectively to stratify patients according to hospital outcome.
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Affiliation(s)
- Rafael Fernandez
- Critical Care Centre, Hospital de Sabadell, Parc Taulí s/n. 08208, Sabadell, Spain
| | - Francisco Baigorri
- Critical Care Centre, Hospital de Sabadell, Parc Taulí s/n. 08208, Sabadell, Spain
| | - Gema Navarro
- Department of Epidemiology, Hospital de Sabadell, Sabadell, Spain
| | - Antonio Artigas
- Critical Care Centre, Hospital de Sabadell, Parc Taulí s/n. 08208, Sabadell, Spain
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Rivera-Fernández R, Navarrete-Navarro P, Fernández-Mondejar E, Rodriguez-Elvira M, Guerrero-López F, Vázquez-Mata G. Six-year mortality and quality of life in critically ill patients with chronic obstructive pulmonary disease. Crit Care Med 2006; 34:2317-24. [PMID: 16849998 DOI: 10.1097/01.ccm.0000233859.01815.38] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the mortality and quality of life (QOL) of survivors at 6 yrs after intensive care unit (ICU) admission for chronic obstructive pulmonary disease. DESIGN Prospective, multiple-center cohort study. SETTING A total of 86 ICUs throughout Spain. PATIENTS Patients in the Project for the Epidemiological Analysis of Critical Care Patients (PAEEC) project with chronic obstructive pulmonary disease were included. MEASUREMENTS AND MAIN RESULTS The sample comprised 742 patients; 508 of them were admitted for acute exacerbation of chronic obstructive pulmonary disease, and 379 of these required intermittent positive-pressure ventilation. The mean age of the patients was 65.2 +/- 9.89 yrs, Acute Physiology and Chronic Health Evaluation (APACHE) III score was 66.6 +/- 21.04; preadmission QOL questionnaire score was 7 +/- 4.82 points, and hospital mortality was 31.8%. At 6 yrs, 32.2% had died after hospital discharge, 21.6% could not be traced, and 107 patients were alive (18.3% of the 582 followed-up patients). QOL of survivors was worse than preadmission (6.55 +/- 5.6 vs. 4.92 +/- 4.5 points, p < .05), but 72% of patients were self-sufficient. Among the 379 patients admitted to the ICU for acute chronic obstructive pulmonary disease exacerbation and requiring intermittent positive-pressure ventilation, 36.7% died in the hospital; at 6 yrs after hospital discharge, 31.4% had died, 18.7% could not be traced, and 50 patients (16.2% of followed-up patients) were alive. Multivariate analysis with logistic regression showed that the mortality at 6 yrs was related to age (odds ratio, 1.046; 95% confidence interval, 1.023-1.071), APACHE III score (odds ratio, 1.013; 95% confidence interval, 1.001-1.024), and preadmission QOL score (odds ratio, 1.139; 95% confidence interval, 1.078-1.204). CONCLUSION The 6-yr mortality of patients with chronic obstructive pulmonary disease requiring ICU admission is high. Mortality is mainly influenced by pre-ICU admission QOL. At 6 yrs, at least 15% are alive; survivors have a worse QOL compared with pre-ICU admission, although three quarters of them are self-sufficient.
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Orwelius L, Nordlund A, Edéll-Gustafsson U, Simonsson E, Nordlund P, Kristenson M, Bendtsen P, Sjöberg F. Role of preexisting disease in patients' perceptions of health-related quality of life after intensive care. Crit Care Med 2005; 33:1557-64. [PMID: 16003062 DOI: 10.1097/01.ccm.0000168208.32006.1c] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To find out how patients perceive their health-related quality of life after they have been treated in an intensive care unit and whether preexisting disease influenced their perception. DESIGN : Follow-up, quantitative, dual-site study. SETTING Combined medical and surgical intensive care units of one university and one general hospital in Sweden. PATIENTS Among the 1,938 patients admitted, 562 were considered eligible (>24 hrs in the intensive care unit, and age >18 yrs). The effect of preexisting disease was assessed by use of a large reference group, a random sample (n = 10,000) of the main intake area of the hospitals. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During 2000-2002, data were collected from the intensive care unit register and from a questionnaire mailed to the patients 6 months after their discharge from hospital. Subjects in the reference group were sent postal questionnaires during 1999. Of the patients in the intensive care unit group, 74% had preexisting diseases compared with 51% in the reference group. Six months after discharge, health-related quality of life was significantly lower among patients than in the reference group. When comparisons were restricted to the previously healthy people in both groups, the observed differences were about halved, and when we compared the patients in the intensive care unit who had preexisting diseases with subjects in the reference group who had similar diseases, we found little difference in perceived health-related quality of life. In some dimensions of health-related quality of life, we found no differences between patients in the intensive care unit and the subjects in the reference population. CONCLUSIONS Preexisting diseases significantly affect the extent of the decline of health-related quality of life after critical care, and this effect may have been underestimated in the past. As most patients who are admitted to an intensive care unit have at least one preexisting disease, it is important to account for these effects when examining outcome.
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Affiliation(s)
- Lotti Orwelius
- Department of Intensive Care, National Centre for Work and Rehabilitation, University/University Hospital of Linköping, Sweden
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Adamson H, Elliott D. Quality of life after a critical illness: A review of general ICU studies 1998–2003. Aust Crit Care 2005. [DOI: 10.1016/s1036-7314(05)80003-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
In reviewing the literature, the authors noted an important variation in stated and observed transfusion practice patterns among pediatric critical care practitioners, and in published guidelines on RBC transfusion. They also noted a paucity of clinical evidence with respect to RBC transfusion to critically ill children. There has been only one large randomized trial in adults, and the authors do not believe that the results from this trial should be generalized to critically ill children because of the many differences in children and their adaptive responses, and differences in disease processes. More research about anemia and RBC transfusion to critically ill children must be performed. The TRIPICU study is testing the safety of giving more or less RBC transfusion to stable critically ill children. Other studies must be done on the epidemiology and determinants of RBC transfusion in PICUs, on prevention of transfusion, and on alternatives to RBC transfusion (eg, erythropoietin).
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Affiliation(s)
- Lars Desmet
- Department of Pediatrics, Faculté de Médecine, Université de Montreal, Quebec, Canada
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Nurok M. Withdrawal of mechanical ventilation. N Engl J Med 2003; 349:2565-7; author reply 2565-7. [PMID: 14695421 DOI: 10.1056/nejm200312253492618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wehler M, Geise A, Hadzionerovic D, Aljukic E, Reulbach U, Hahn EG, Strauss R. Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Crit Care Med 2003; 31:1094-101. [PMID: 12682478 DOI: 10.1097/01.ccm.0000059642.97686.8b] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine health-related quality of life in medical intensive care patients with multiple organ dysfunction. DESIGN Prospective, observational study. SETTING A 12-bed, noncoronary, medical intensive care unit of a university hospital. PATIENTS Between June 1998 and May 1999, 318 consecutively admitted adult patients with an intensive care unit stay of >24 hrs were studied. MEASUREMENTS AND MAIN RESULTS Health-related quality of life was assessed using a generic instrument, the Medical Outcomes Study Short Form-36 Health Survey, at admission and at 6-month follow-up. Patients who developed multiple organ dysfunction (n = 170) consumed 85% of the therapeutic activity provided in the intensive care unit. Compared with age- and sex-adjusted general population controls, multiple organ dysfunction patients had a worse preadmission health-related quality of life than other intensive care unit patients, predominantly due to a higher burden of comorbid disease. In a multivariate analysis, multiple organ dysfunction was the only variable independently associated with deteriorated physical health domains at follow-up (odds ratio, 4.4; 95% confidence interval, 1.3-14.6; p =.015), but it had no impact on dimensions of mental health. Analyzing the impact of different organ system failures, respiratory failure (odds ratio, 4.1; 95% confidence interval, 1.6-10.3; p =.002) and acute renal failure (odds ratio, 3.3; 95% confidence interval, 1.0-11.5; p =.05) increased the risk of deteriorated physical health at follow-up. No impact of the various organ system failures on mental health was noted. At 6-month follow-up, 83-90% of survivors had regained their previous health-related quality of life, and 94% were living at home with their families. CONCLUSIONS This study has shown that preadmission health-related quality of life of our medical, noncoronary patients was substantially reduced compared with a matched general population. This demonstrates the need to take prehospitalization health-related quality of life into account when examining the outcomes of intensive care unit survivors. Multiple organ dysfunction was the major determinant of poor physical health at follow-up, but it had no impact on mental health domains.
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Affiliation(s)
- Markus Wehler
- Departments of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany
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Abstract
PURPOSE OF REVIEW End-of-life decisions play an important role in the intensive care unit. This review discusses the most important studies on end-of-life decisions published from October 2001 to October 2002. RECENT FINDINGS Refusal of admission to the intensive care unit in itself is frequently an end-of-life decision. However, some patients survive rejection. The main end-of-life decisions during intensive care unit stay are withholding or withdrawal of therapy. Some patients have do-not-resuscitate orders on admittance to a unit. The effect of family participation and involvement of other caregivers in such decisions has been extensively studied. Such participation can lead to anxiety and depression in the family. A procedural guideline for decision making is of clinical interest. The background of physicians plays an important role. Terminal sedation and analgesia play an important role in execution of end-of-life decisions. During intensive care unit admission there is a continuous change in circumstances, which causes continuous differences in the wishes of the patients and relatives. The small contribution of the cost of the last days of life to total healthcare cost was reconfirmed. SUMMARY The new studies put emphasis on the facts that all care providers should participate in the decision and that communication with surrogates is of extreme importance. Many valid points from other medical fields also apply to the intensive care unit situation.
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Affiliation(s)
- Leo H D J Booij
- Department of Anaesthesiology, University Medical Centre Nijmegen, The Netherlands.
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Vazquez G, Benito S, Rivera R. Simplified Acute Physiology Score III: a project for a new multidimensional tool for evaluating intensive care unit performance. Crit Care 2003; 7:345-6. [PMID: 12974964 PMCID: PMC270708 DOI: 10.1186/cc2163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Simplified Acute Physiology Score III Outcomes Research Group is developing an international multidimensional instrument for the global evaluation of intensive care unit performance. Among its specific objectives are the update of a severity of illness index (Simplified Acute Physiology Score) with a mortality prediction equation, with the hindsight of recent years, and the creation or application of novel instruments in the areas of infections and cost-effectiveness. Some important measurements such as the quality of life and the satisfaction of patients and professionals are not included. A further aim is the achievement of international validation.
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Affiliation(s)
- Guillermo Vazquez
- Departamento de Medicina y Urgencias, Hospital de la Santa Cruz y San Pablo, Barcelona, Spain.
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Abstract
During the past 20 years, ICU risk-prediction models have undergone significant development, validation, and refinement. Among the general ICU severity of illness scoring systems, the Acute Physiology and Chronic Health Evaluation (APACHE), Mortality Prediction Model (MPM), and the Simplified Acute Physiology Score (SAPS) have become the most accepted and used. To risk-adjust patients with longer, more severe illnesses like sepsis and acute respiratory distress syndrome, several models of organ dysfunction or failure have become available, including the Multiple Organ Dysfunction Score (MODS), the Sequential Organ Failure Assessment (SOFA), and the Logistic Organ Dysfunction Score (LODS). Recent innovations in risk adjustment include automatic physiology and diagnostic variable retrieval and the use of artificial intelligence. These innovations have the potential of extending the uses of case-mix and severity-of-illness adjustment in the areas of clinical research, patient care, and administration. The challenges facing intensivists in the next few years are to further develop these models so that they can be used throughout the IUC stay to assess quality of care and to extend them to more specific patient groups such as the elderly and patients with chronic ICU courses.
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Affiliation(s)
- Andrew L Rosenberg
- Robert Wood Johnson Clinical Scholars Program, Department of Anesthesiology and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan 48109-4270, USA.
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Bewley J. Does quality of life affect outcome? Crit Care 2001. [DOI: 10.1186/ccf-2001-73602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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