Predictors of Functional Status at Discharge After Medical Intensive Care Unit Admission Among Patients With Lung Transplantation.

Abstract

Purpose: Increasing number of lung transplantation (LT) are undergoing every year. Many such patients have episodes of decompensation requiring admission to medical intensive care unit (MICU) beyond their peri-operative period. In the current study, we sought to evaluate outcomes related to functional status at the time of discharge and identify clinical predictors that may be potentially useful for identifying patients for early intervention. Methods: Between July 2011-2012, 101 patients with history of LT were admitted (mean age 55.4 ± 12.6 years, M:F 53:48, Caucasians 89%). Among these, 88 patients survived to hospital discharge (87.1%, mean age 55±12.3 years, M:F 45:43) %). Data regarding baseline variables, pre-admission FEV1, indication for MICU admission, need of ventilator support, length of MICU stay and functional status at discharge was recorded. Functional status was classified aS independent, partially dependent or fully dependent at the time of hospital discharge on the basis of assistance needed to accomplish activities of daily living. Patients with partial or full dependence were merged into one group. Variables were compared between patients who functionally independent versus those who were dependent at the time of discharge. Results Majority of the patients had functional disabilities at the time of discharge (partially dependent: 35/88, 40% and fully dependent: 14/88, 16%). On univariate analysis, type of transplant (odds ratio, 95% CI: 1.97, 1.28-3.0, P=0.004), high acute physiology score (57.3±22.8 vs 46.7±16.8, P=0.018), low serum albumin (SA) (2.75±0.64 vs 3.17±0.61, P=0.004), need of invasive ventilation (odds ratio, 95% CI: 2.46, 1.44-4.2, P<0.001) and higher MICU length of stay (LOS) (8.8±8.3 vs 3.3±3.2, P<0.001) were associated with dependent functional status. Among these, low SA (adjusted OR, 95% CI: 2.9, 1.04-8.25; P=0.045) and high MICU LOS (adjusted OR, 95% CI: 1.21, 1.03-2.62; P=0.02) were independent predictors of functional status. A MICU LOS >3 days (odds ratio, 95% CI: 2.2, 1.3-3.7, P=0.002) and SA<2.75 (odds ratio, 95% CI: 2.1, 1.1-5.0, P=0.008) were identified as the best cut-off for prediction of functional status as discharge. Conclusions SA levels at admission and LOS in the unit are independent predictors of discharge functional status. These predictors may be useful in identification of patients that may benefit by aggressive nutritional support and physical therapy whenever appropriate.