David M Griffith1, Lisa G Salisbury2, Robert J Lee3, Nazir Lone1, Judith L Merriweather1, Timothy S Walsh1. 1. Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. 2. Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, Queen Margaret University, Edinburgh, United Kingdom. 3. Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom.
Abstract
OBJECTIVES: ICU survivors frequently report reduced health-related quality of life, but the relative importance of preillness versus acute illness factors in survivor populations is not well understood. We aimed to explore health-related quality of life trajectories over 12 months following ICU discharge, patterns of improvement, or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), preexisting health (Functional Comorbidity Index), and acute illness severity (Acute Physiology and Chronic Health Evaluation II score, ventilation days) as determinants of health-related quality of life and relevant patient-reported symptoms during the year following ICU discharge. DESIGN: Nested cohort study within a previously published randomized controlled trial. SETTING: Two ICUs in Edinburgh, Scotland. PATIENTS: Adult ICU survivors (n = 240) who required more than 48 hours of mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We prospectively collected data for age, gender, social deprivation (Scottish index of multiple deprivation), preexisting comorbidity (Functional Comorbidity Index), Acute Physiology and Chronic Health Evaluation II score, and days of mechanical ventilation. Health-related quality of life (Medical Outcomes Study Short Form version 2 Physical Component Score and Mental Component Score) and patient-reported symptoms (appetite, fatigue, pain, joint stiffness, and breathlessness) were measured at 3, 6, and 12 months. MeanPhysical Component Score and Mental Component Score were reduced at all time points with minimal change between 3 and 12 months. In multivariable analysis, increasing pre-ICU comorbidity count was strongly associated with lower health-related quality of life (Physical Component Score β = -1.56 [-2.44 to -0.68]; p = 0.001; Mental Component Score β = -1.45 [-2.37 to -0.53]; p = 0.002) and more severe self-reported symptoms. In contrast, Acute Physiology and Chronic Health Evaluation II score and mechanical ventilation days were not associated with health-related quality of life. Older age (β = 0.33 [0.19-0.47]; p < 0.001) and lower social deprivation (β = 1.38 [0.03-2.74]; p = 0.045) were associated with better Mental Component Score health-related quality of life. CONCLUSIONS: Preexisting comorbidity counts, but not severity of ICU illness, are strongly associated with health-related quality of life and physical symptoms in the year following critical illness.
RCT Entities:
OBJECTIVES: ICU survivors frequently report reduced health-related quality of life, but the relative importance of preillness versus acute illness factors in survivor populations is not well understood. We aimed to explore health-related quality of life trajectories over 12 months following ICU discharge, patterns of improvement, or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), preexisting health (Functional Comorbidity Index), and acute illness severity (Acute Physiology and Chronic Health Evaluation II score, ventilation days) as determinants of health-related quality of life and relevant patient-reported symptoms during the year following ICU discharge. DESIGN: Nested cohort study within a previously published randomized controlled trial. SETTING: Two ICUs in Edinburgh, Scotland. PATIENTS: Adult ICU survivors (n = 240) who required more than 48 hours of mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We prospectively collected data for age, gender, social deprivation (Scottish index of multiple deprivation), preexisting comorbidity (Functional Comorbidity Index), Acute Physiology and Chronic Health Evaluation II score, and days of mechanical ventilation. Health-related quality of life (Medical Outcomes Study Short Form version 2 Physical Component Score and Mental Component Score) and patient-reported symptoms (appetite, fatigue, pain, joint stiffness, and breathlessness) were measured at 3, 6, and 12 months. Mean Physical Component Score and Mental Component Score were reduced at all time points with minimal change between 3 and 12 months. In multivariable analysis, increasing pre-ICU comorbidity count was strongly associated with lower health-related quality of life (Physical Component Score β = -1.56 [-2.44 to -0.68]; p = 0.001; Mental Component Score β = -1.45 [-2.37 to -0.53]; p = 0.002) and more severe self-reported symptoms. In contrast, Acute Physiology and Chronic Health Evaluation II score and mechanical ventilation days were not associated with health-related quality of life. Older age (β = 0.33 [0.19-0.47]; p < 0.001) and lower social deprivation (β = 1.38 [0.03-2.74]; p = 0.045) were associated with better Mental Component Score health-related quality of life. CONCLUSIONS: Preexisting comorbidity counts, but not severity of ICU illness, are strongly associated with health-related quality of life and physical symptoms in the year following critical illness.
Authors: Sheetal Gandotra; James Lovato; Douglas Case; Rita N Bakhru; Kevin Gibbs; Michael Berry; D Clark Files; Peter E Morris Journal: Ann Am Thorac Soc Date: 2019-04
Authors: Sean M Bagshaw; Henry T Stelfox; Theodore J Iwashyna; Rinaldo Bellomo; Dan Zuege; Xioaming Wang Journal: Intensive Care Med Date: 2018-11-12 Impact factor: 17.440
Authors: Jerry J Zimmerman; Russell Banks; Robert A Berg; Athena Zuppa; Christopher J Newth; David Wessel; Murray M Pollack; Kathleen L Meert; Mark W Hall; Michael Quasney; Anil Sapru; Joseph A Carcillo; Patrick S McQuillen; Peter M Mourani; Hector Wong; Ranjit S Chima; Richard Holubkov; Whitney Coleman; Samuel Sorenson; James W Varni; Julie McGalliard; Wren Haaland; Kathryn Whitlock; J Michael Dean; Ron W Reeder Journal: Crit Care Med Date: 2020-03 Impact factor: 7.598
Authors: Mohamed D Hashem; Ramona O Hopkins; Elizabeth Colantuoni; Victor D Dinglas; Pratik Sinha; Lisa Aronson Friedman; Peter E Morris; James C Jackson; Catherine L Hough; Carolyn S Calfee; Dale M Needham Journal: Thorax Date: 2021-06-10 Impact factor: 9.139
Authors: Wytske W Geense; Mark van den Boogaard; Marco A A Peters; Koen S Simons; Esther Ewalds; Hester Vermeulen; Johannes G van der Hoeven; Marieke Zegers Journal: Crit Care Med Date: 2020-09 Impact factor: 9.296