Anna Milton1,2, Anna Schandl3, Iwo Soliman4, Eva Joelsson-Alm5,6, Mark van den Boogaard7, Ewa Wallin8, Camilla Brorsson9, Ulrika Östberg10, Kristine Latocha11, Johanna Savilampi12,13, Stinne Paskins14, Matteo Bottai15, Peter Sackey1. 1. Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden. 2. Department of Perioperative Medicine and Intensive care, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden. 4. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 5. Department of Clinical Science and Education, Karolinska Institutet, Solna, Sweden. 6. Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden. 7. Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. 8. Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden. 9. Department of Surgical and Perioperative Sciences, Umeå University, Umea, Sweden. 10. Department of Anaesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden. 11. Department of Intensive Care, Rigshospitalet Copenhagen, Copenhagen, Denmark. 12. School of medical sciences, Örebro University, Örebro, Sweden. 13. Department of Anaesthesiology and Intensive care, Örebro University Hospital, Örebro, Sweden. 14. Department of Intensive Care, Odense University Hospital, Odense, Denmark. 15. Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.
Abstract
BACKGROUND: Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge. METHODS: Multinational prospective cohort study in 10 general ICUs in Sweden, Denmark, and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability 3 months post-ICU, defined as a ≥10 score reduction in the Barthel Index (BI) compared to baseline. RESULTS: Of the 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea critical care physical assessment tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81-0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61-0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, and positive predictive value for a high-risk group (CPAx score ≤18) was 0.32. CONCLUSION: The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.
BACKGROUND: Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge. METHODS: Multinational prospective cohort study in 10 general ICUs in Sweden, Denmark, and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability 3 months post-ICU, defined as a ≥10 score reduction in the Barthel Index (BI) compared to baseline. RESULTS: Of the 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea critical care physical assessment tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81-0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61-0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, and positive predictive value for a high-risk group (CPAx score ≤18) was 0.32. CONCLUSION: The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.
Authors: Matthew H Anstey; Rashmi Rauniyar; Ethan Fitzclarence; Natalie Tran; Emma Osnain; Bianca Mammana; Angela Jacques; Robert N Palmer; Andrew Chapman; Bradley Wibrow Journal: Acute Crit Care Date: 2022-06-27