Abstract
Post-intensive care unit (ICU) sequelae, including physical and mental health problems, are relatively unexplored. Characteristics commonly used to predict outcome lack prognostic value when it comes to long-term physical recovery. Therefore, the objective of this study was to assess the incidence of non-recovery in long-stay ICU-patients. In this single-centre study, retrospective data of adults with an ICU stay >48 hours who visited the specialized post-ICU clinic, and completed the Dutch RAND 36-item Short Form questionnaire at 3 and 12 months post-ICU, were retrieved from electronic patient records. In cases where physical functioning scores at 12 months were below reference values, patients were allocated to the physical non-recovery (NR) group. Significantly different baseline and (post-)ICU-characteristics were assessed for correlations with physical recovery at 12 months post-ICU. Of 250 patients, 110 (44%) fulfilled the criteria for the NR-group. Neither the severity of illness, type of admission, nor presence of sepsis did not differ between groups. However, NR-patients had a higher age, were more often female, and had a higher incidence of co-morbidities. Shorter LOS ICU, lower incidence of medical comorbidities, and better physical performance at 3 months were significantly correlated with 1-year physical recovery. Comorbidities and reduced physical functioning at 3 months were identified as independent risk-factors for long-term physical non-recovery. In conclusion, a substantial proportion of long-stay ICU-patients who visited the standard care post-ICU clinic did not fulfil the criteria for full physical recovery at 12 months post-ICU. Commonly used ICU-characteristics, such as severity of illness, do not have sufficient prognostic value when it comes to long-term recovery of health-related quality of life.
Highlights
Over the past decades, both hospital mortality and long-term mortality of intensive care unit (ICU) patients have declined [1, 2]
Data of patients who did not survive until the 1 year follow-up, were lost to follow-up, or who did not complete the physical functioning (PF) domain of the questionnaire were excluded from analysis (Fig 1)
NR-patients had a significantly lower PF-domain score at 3 months compared to the R-patients (PF-subscale score at 3 months: 38 [25–55], 75 [60–85], respectively. p < 0.001)
Summary
Both hospital mortality and long-term mortality of intensive care unit (ICU) patients have declined [1, 2]. ADL-performance seems to be a strong indicator of self-efficacy at the moment of ICU or hospital discharge and is often used to identify short-term care needs [3]. These outcomes may be poor estimates of long-term prognosis. This short-term focus on recovery often does not equate the impact of critical illness in the long run
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