Abstract
BackgroundThis study aimed to understand the impact of a critical care admission on long-term outcomes, compared to other hospitalised patients without a critical care encounter. A secondary aim was to examine the interrelationship between emotional, physical, and social problems during recovery.MethodsWe utilised data from the UK Biobank, an on-going, prospective population-based cohort study. We employed propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital (first admission to hospital available) without critical care. Structural equation modelling was used to analyse emotional, physical and social outcomes following critical illness and the relationships between these health domains.FindingsData from 1,618 patients were analysed. The median time to follow-up in the critical care cohort was 4427 days (IQR:788–6146) vs 4516 days (IQR: 811–6369) in the non-critical care, hospitalised cohort. Across the two time periods assessed (pre and post 2000), patients exposed to critical care were more likely to experience mental health issues such as depression (p < 0.01) and social isolation (p = 0.01) following discharge from hospital. The critical care cohort were also more likely to have social problems such as the requirement for government funded welfare support (p = 0.02). In the critical care cohort, social and emotional health were closely correlated (p < 0.001, 95% CI:0.33–0.54). The nature of physical problems changed over time; pre-2000 there was a significant difference between the critical and non-critical care in physical outcomes following discharge from hospital, however, there was no difference detected between the two cohorts post-2000.InterpretationThis cohort study has demonstrated that survivors of critical illness have different psycho-social outcomes to matched patients, hospitalised without a critical care encounter.FundingJM is funded by a THIS.Institute (University of Cambridge) Research Fellowship (PD-2019–02–16). AHL is part of the Social and Public Health Sciences Unit, funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).
Highlights
Patients who have been admitted to an Intensive Care Unit (ICU) are known to be at risk for long-term problems [1,2]
This has led to increased debate about whether Post Intensive Care Syndrome (PICS) is a unique feature of ICU survivorship or, the poor long-term outcomes seen are merely a feature of pre-existing or deteriorating chronic conditions present before ICU admission [11,12]
We sought to advance the literature by using data from the UK Biobank to ask: (a) what is the interrelationship between emotional, physical, and social problems amongst patients following a critical care admission? (b) to what extent is care in critical care associated with worse recovery? We focus on survivors, as it is well known that ICU patients face worse short-term mortality
Summary
Patients who have been admitted to an Intensive Care Unit (ICU) are known to be at risk for long-term problems [1,2]. There is limited randomised trial evidence demonstrating the benefit of any specific intervention [10] This has led to increased debate about whether PICS is a unique feature of ICU survivorship or, the poor long-term outcomes seen are merely a feature of pre-existing or deteriorating chronic conditions present before ICU admission [11,12]. This study aimed to understand the impact of a critical care admission on long-term outcomes, compared to other hospitalised patients without a critical care encounter. Interpretation: This cohort study has demonstrated that survivors of critical illness have different psychosocial outcomes to matched patients, hospitalised without a critical care encounter
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