Naoya Yanagi1, Kentaro Kamiya1,2, Nobuaki Hamazaki3, Ryota Matsuzawa4, Kohei Nozaki3, Takafumi Ichikawa3, Thomas S Valley5,6,7, Takeshi Nakamura1,8, Masashi Yamashita1, Emi Maekawa9, Tomotaka Koike10, Minako Yamaoka-Tojo2,11, Masayasu Arai12, Atsuhiko Matsunaga1,2, Junya Ako9,11. 1. Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan. 2. Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan. 3. Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan. 4. Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan. 5. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America. 6. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States of America. 7. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States of America. 8. Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan. 9. Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Sagamihara, Japan. 10. Department of Intensive Care Center, Kitasato University Hospital, Sagamihara, Japan. 11. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan. 12. Division of Intensive Care Medicine, Department of Research and Development Center for New Medical Frontiers, School of Medicine, Kitasato University, Sagamihara, Japan.
Abstract
INTRODUCTION: The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness. MATERIALS AND METHODS: In this retrospective cohort study, we identified 248 critically ill patients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality. RESULTS: Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patients died. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 - 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623). CONCLUSION: While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.
INTRODUCTION: The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness. MATERIALS AND METHODS: In this retrospective cohort study, we identified 248 critically illpatients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality. RESULTS:Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patientsdied. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 - 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623). CONCLUSION: While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.
Authors: Timothy D Girard; James C Jackson; Pratik P Pandharipande; Brenda T Pun; Jennifer L Thompson; Ayumi K Shintani; Sharon M Gordon; Angelo E Canonico; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: Crit Care Med Date: 2010-07 Impact factor: 7.598
Authors: J L Vincent; R Moreno; J Takala; S Willatts; A De Mendonça; H Bruining; C K Reinhart; P M Suter; L G Thijs Journal: Intensive Care Med Date: 1996-07 Impact factor: 17.440
Authors: Dale M Needham; Judy Davidson; Henry Cohen; Ramona O Hopkins; Craig Weinert; Hannah Wunsch; Christine Zawistowski; Anita Bemis-Dougherty; Susan C Berney; O Joseph Bienvenu; Susan L Brady; Martin B Brodsky; Linda Denehy; Doug Elliott; Carl Flatley; Andrea L Harabin; Christina Jones; Deborah Louis; Wendy Meltzer; Sean R Muldoon; Jeffrey B Palmer; Christiane Perme; Marla Robinson; David M Schmidt; Elizabeth Scruth; Gayle R Spill; C Porter Storey; Marta Render; John Votto; Maurene A Harvey Journal: Crit Care Med Date: 2012-02 Impact factor: 7.598
Authors: Bernard De Jonghe; Sylvie Bastuji-Garin; Marie-Christine Durand; Isabelle Malissin; Pablo Rodrigues; Charles Cerf; Hervé Outin; Tarek Sharshar Journal: Crit Care Med Date: 2007-09 Impact factor: 7.598
Authors: Luuk Wieske; Daniela S Dettling-Ihnenfeldt; Camiel Verhamme; Frans Nollet; Ivo N van Schaik; Marcus J Schultz; Janneke Horn; Marike van der Schaaf Journal: Crit Care Date: 2015-04-27 Impact factor: 9.097