Abstract
IntroductionIn this study, we evaluated the impacts of organ failure and residual dysfunction on 1-year survival and health care resource use using Intensive Care Unit (ICU) discharge as the starting point.MethodsWe conducted a historical cohort study, including all adult patients discharged alive after at least 72 h of ICU stay in a tertiary teaching hospital in Brazil. The starting point of follow-up was ICU discharge. Organ failure was defined as a value of 3 or 4 in its corresponding component of the Sequential Organ Failure Assessment score, and residual organ dysfunction was defined as a score of 1 or 2. We fit a multivariate flexible Cox model to predict 1-year survival.ResultsWe analyzed 690 patients. Mortality at 1 year after discharge was 27 %. Using multivariate modeling, age, chronic obstructive pulmonary disease, cancer, organ dysfunctions and albumin at ICU discharge were the main determinants of 1-year survival. Age and organ failure were non-linearly associated with survival, and the impact of organ failure diminished over time. We conducted a subset analysis with 561 patients (81 %) discharged without organ failure within the previous 24 h of discharge, and the number of residual organs in dysfunction remained strongly associated with reduced 1-year survival. The use of health care resources among hospital survivors was substantial within 1 year: 40 % of the patients were rehospitalized, 52 % visited the emergency department, 90 % were seen at the outpatient clinic, 14 % attended rehabilitation outpatient services, 11 % were followed by the psychological or psychiatric service and 7 % used the day hospital facility. Use of health care resources up to 30 days after hospital discharge was associated with the number of organs in dysfunction at ICU discharge.ConclusionsOrgan failure was an important determinant of 1-year outcome of critically ill survivors. Nevertheless, the impact of organ failure tended to diminish over time. Resource use after critical illness was elevated among ICU survivors, and a targeted action is needed to deliver appropriate care and to reduce the late critical illness burden.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0986-6) contains supplementary material, which is available to authorized users.
Highlights
In this study, we evaluated the impacts of organ failure and residual dysfunction on 1-year survival and health care resource use using Intensive Care Unit (ICU) discharge as the starting point
Baseline characteristics Of the 1462 patients admitted to the ICU during the study period, 690 patients were discharged alive after a stay of at least 72 h and were included in the present analysis (Additional file 1: Figure S1)
Following ICU discharge, hospital mortality for the index hospitalization was 18 % (Table 3). For those patients discharged from the hospital, 1-year mortality was 9 %, totaling 27 % of 1-year mortality for patients discharged alive after a 72-h ICU stay
Summary
We evaluated the impacts of organ failure and residual dysfunction on 1-year survival and health care resource use using Intensive Care Unit (ICU) discharge as the starting point. The burden of organ failure, exacerbated inflammatory response and other events (e.g., endothelial activation, physiological derangements) that occur during the acute phase of critical illness are clearly associated with poor short-term outcomes, as captured by ICU and hospital mortality. The cumulative [25] and peak maximum organ failure [26] were associated with long-term mortality; in a large cohort of patients with septic shock, the impacts of these factors seemed to be strongest only early after admission [28]. Researchers in a recent study differentiated the determinants of short- and long-term survival after critical illness [1]. Considering the dynamic process of critical illness, this approach is fundamental for the prognostication and discussion of treatment plans, for research and for prevention from both the patient and health system perspectives [1, 26, 31]
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