Quality of life and survival following intensive medical care.

The relation between quality of life before admission and the outcome of admissions to the intensive care unit (ICU) was studied prospectively among 126 patients in a community hospital with a predominantly geriatric patient population. Fifty-four per cent of our patients were older than 65 years and 66 per cent suffered from chronic ill health. Their mean APACHE score was 18 +/- 8 (mean +/- SD). Quality of life was assessed by the Karnofsky index of physical performance; the linear analogue self assessment (LASA) score; sleep index; level of employment; sexual activity; housing status. Thirty-seven per cent of the patients died in ICU and another 10 per cent in hospital. The one year survival of the entire group was 37 per cent. Survival rates were significantly higher in patients with a Karnofsky index of 6 or more, LASA score of 55 or more, in employment, and with sleep index of 2 or more (p less than 0.05). The 12-month survival among patients with four favourable indicators was 59 per cent, with two or three favourable indicators 36 per cent (p less than 0.05), and in patients with no favourable indicators of quality of life or only one 17 per cent (p less than 0.001). Quality of life in patients who survived longer than six months after ICU care was high (Karnofsky index 7.9 +/- 2.0; LASA score 71 +/- 20 (mean +/- SD) and unimpaired when compared with their ratings before admission to the unit. These findings indicate that quality of life before admission is an important predictor of survival and that a high proportion of critically-ill subjects whose quality of life was relatively good before the episode requiring admission will be long-term survivors whose quality of life is comparable to that preceding critical care.