A M Higgins1, A Serpa Neto1,2,3,4, M Bailey1,2, J Barrett5,6, R Bellomo1,2,3, D J Cooper1,7, B J Gabbe8, N Linke1, P S Myles8,9, M Paton1,10, S Philpot11, M Shulman8,9, M Young7, C L Hodgson12,13. 1. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia. 2. Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia. 3. Department of Intensive Care, Austin Health, Melbourne, VIC, Australia. 4. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil. 5. Intensive Care Unit, Epworth Healthcare, Melbourne, VIC, Australia. 6. Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia. 7. Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia. 8. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. 9. Department of Anaesthesiology and Perioperative Medicine, The Alfred, Melbourne, VIC, Australia. 10. Department of Physiotherapy, Monash Health, Melbourne, VIC, Australia. 11. Intensive Care Unit, Cabrini Health, Melbourne, VIC, Australia. 12. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia. carol.hodgson@monash.edu. 13. Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia. carol.hodgson@monash.edu.
Abstract
PURPOSE: This study aimed to determine the prevalence and predictors of death or new disability following critical illness. METHODS: Prospective, multicentre cohort study conducted in six metropolitan intensive care units (ICU). Participants were adults admitted to the ICU who received more than 24 h of mechanical ventilation. The primary outcome was death or new disability at 6 months, with new disability defined by a 10% increase in the WHODAS 2.0. RESULTS: Of 628 patients with the primary outcome available (median age of 62 [49-71] years, 379 [61.0%] had a medical admission and 370 (58.9%) died or developed new disability by 6 months. Independent predictors of death or new disability included age [OR 1.02 (1.01-1.03), P = 0.001], higher severity of illness (APACHE III) [OR 1.02 (1.01-1.03), P < 0.001] and admission diagnosis. Compared to patients with a surgical admission diagnosis, patients with a cardiac arrest [OR (95% CI) 4.06 (1.89-8.68), P < 0.001], sepsis [OR (95% CI) 2.43 (1.32-4.47), P = 0.004], or trauma [OR (95% CI) 6.24 (3.07-12.71), P < 0.001] diagnosis had higher odds of death or new disability, while patients with a lung transplant [OR (95% CI) 0.21 (0.07-0.58), P = 0.003] diagnosis had lower odds. A model including these three variables had good calibration (Brier score 0.20) and acceptable discriminative power with an area under the receiver operating characteristic curve of 0.76 (95% CI 0.72-0.80). CONCLUSION: Less than half of all patients mechanically ventilated for more than 24 h were alive and free of new disability at 6 months after admission to ICU. A model including age, illness severity and admission diagnosis has acceptable discriminative ability to predict death or new disability at 6 months.
PURPOSE: This study aimed to determine the prevalence and predictors of death or new disability following critical illness. METHODS: Prospective, multicentre cohort study conducted in six metropolitan intensive care units (ICU). Participants were adults admitted to the ICU who received more than 24 h of mechanical ventilation. The primary outcome was death or new disability at 6 months, with new disability defined by a 10% increase in the WHODAS 2.0. RESULTS: Of 628 patients with the primary outcome available (median age of 62 [49-71] years, 379 [61.0%] had a medical admission and 370 (58.9%) died or developed new disability by 6 months. Independent predictors of death or new disability included age [OR 1.02 (1.01-1.03), P = 0.001], higher severity of illness (APACHE III) [OR 1.02 (1.01-1.03), P < 0.001] and admission diagnosis. Compared to patients with a surgical admission diagnosis, patients with a cardiac arrest [OR (95% CI) 4.06 (1.89-8.68), P < 0.001], sepsis [OR (95% CI) 2.43 (1.32-4.47), P = 0.004], or trauma [OR (95% CI) 6.24 (3.07-12.71), P < 0.001] diagnosis had higher odds of death or new disability, while patients with a lung transplant [OR (95% CI) 0.21 (0.07-0.58), P = 0.003] diagnosis had lower odds. A model including these three variables had good calibration (Brier score 0.20) and acceptable discriminative power with an area under the receiver operating characteristic curve of 0.76 (95% CI 0.72-0.80). CONCLUSION: Less than half of all patients mechanically ventilated for more than 24 h were alive and free of new disability at 6 months after admission to ICU. A model including age, illness severity and admission diagnosis has acceptable discriminative ability to predict death or new disability at 6 months.
Authors: Carol L Hodgson; Alisa M Higgins; Michael Bailey; Jonathon Barrett; Rinaldo Bellomo; D James Cooper; Belinda J Gabbe; Theodore Iwashyna; Natalie Linke; Paul S Myles; Michelle Paton; Steve Philpot; Mark Shulman; Meredith Young; Ary Serpa Neto Journal: Crit Care Date: 2022-06-13 Impact factor: 19.334