Health-related quality of life as predictor for mortality in patients treated with long-term mechanical ventilation

Heidi Markussen,Roy M Nilsen,Gerd K Natvig,Sverre Lehmann

doi:10.1186/s12890-018-0768-4

Abstract

BackgroundThe Severe Respiratory Insufficiency (SRI) questionnaire is a specific measure of health-related quality of life (HRQoL) in patients treated with long-term mechanical ventilation (LTMV). The aim of the present study was to examine whether SRI sum scores and related subscales are associated with mortality in LTMV patients.MethodsThe study included 112 LTMV patients (non-invasive and invasive) from the Norwegian LTMV registry in Western Norway from 2008 with follow-up in August 2014. SRI data were obtained through a postal questionnaire, whereas mortality data were obtained from the Norwegian Cause of Death Registry. The SRI questionnaire contains 49 items and seven subscales added into a summary score (range 0–100) with higher scores indicating a better HRQoL. The association between the SRI score and mortality was estimated as hazard ratios (HRs) with 95% confidence intervals (95% CI) using Cox regression models and HRs were estimated per one unit change in the SRI score.ResultsOf the 112 participating patients in 2008, 52 (46%) had died by August 2014. The mortality rate was the highest in patients with chronic obstructive pulmonary disease (75%), followed by patients with neuromuscular disease (46%), obesity hypoventilation syndrome (31%) and chest wall disease (25%) (p < 0.001). Higher SRI sum scores in 2008 were associated with a lower mortality risk after adjustment for age, education, hours a day on LTMV, time since initiation of LTMV, disease category and comorbidity (HR 0.98, 95% CI: 0.96–0.99). In addition, SRI-Physical Functioning (HR 0.98, 95% CI: 0.96–0.99), SRI-Psychological Well-Being (HR 0.98, 95% CI: 0.97–0.99), and SRI-Social Functioning (HR 0.98, 95% CI: 0.97–0.99) remained significant risk factors for mortality after covariate adjustment. In the subgroup analyses of patient with neuromuscular diseases we found significant inverse associations between some of the SRI subscales and mortality.ConclusionsSRI score is associated with mortality in LTMV-treated patients. We propose the use of SRI in the daily clinic with repeated measurements as part of individual follow-up. Randomized clinical trials with interventions aimed to improve HRQoL in LTMV patients should consider the SRI questionnaire as the standard HRQoL measurement.

Highlights

The Severe Respiratory Insufficiency (SRI) questionnaire is a specific measure of health-related quality of life (HRQoL) in patients treated with long-term mechanical ventilation (LTMV)
Assistance to complete the SRI questionnaire was reported by 26% of the study participants
By Kaplan-Meier survival analyses (Fig. 2), we found that patients with chronic obstructive pulmonary disease (COPD) had the highest overall mortality rate (75%), followed by patients with neuromuscular diseases (NMD) (46%), obesity hypoventilation syndrome (OHS) (31%) and chest wall diseases (CWD) (25%) (p < 0.001) (Fig. 2)

Summary

Introduction

The Severe Respiratory Insufficiency (SRI) questionnaire is a specific measure of health-related quality of life (HRQoL) in patients treated with long-term mechanical ventilation (LTMV). Long-term mechanical ventilation (LTMV) is a treatment for patients with CHRF due to different aetiologies and includes both non-invasive and invasive mechanical ventilation [2,3,4]. One of the exceptions is RCTs involving COPD patients with CHRF, where the benefit of LTMV on survival has been and continues to be debated [3, 5, 6]. Two recent RCTs found improved one-year mortality in COPD patients treated with non-invasive LTMV [7, 8]. One of the few RCTs in this heterogenic category found improved mortality in patients with amyotrophic lateral sclerosis (ALS) [9]

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