Long-term treated intensive care patients outcomes: the one-year mortality rate, quality of life, health care use and long-term complications as reported by general practitioners

BMC Anesthesiology

Simone Steenbergen¹  Saskia Rijkenberg¹  Tamara Adonis¹  Gerda Kroeze¹  Ilse van Stijn¹  Henrik Endeman¹ 

[1] Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, 1090 HM, The Netherlands

关键词: Long-term complications;    Use of healthcare;    Home return;    Health related quality of life;    One-year mortality;    Intensive care unit;   

Others  :  1228353
DOI  :  10.1186/s12871-015-0121-x

 received in 2015-01-08, accepted in 2015-10-03,  发布年份 2015

【 摘 要 】

Background

The purpose of this study was to determine the one-year mortality rate and its predictors regarding long-term intensive care-treated patients together with their health-related quality of life (HRQL), place of living, healthcare use and long-term complication characteristics after intensive care unit (ICU) discharge.

Methods

A retrospective cohort study was performed in a 20-bed mixed ICU. The patients that were treated for more than 72 h between 2007 and 2012 were included in this study. The one-year mortality rate was calculated, and the characteristics of the ICU survivors that died within one year after ICU discharge were further analysed. For all patients, the Dutch version of the SF-36 questionnaire was used to assess their current HRQL. The results were compared with a normal population. Additionally, patients were questioned about their place of living, and their general practitioners (GPs) were questioned about the patients’ possible long-term complications.

Results

Seven hundred and forty patients were included in this study, and their one-year mortality rate was 28 %, of which half died within the first week after ICU discharge. The one-year mortality rate predictors included age at the time of ICU admission, APACHE IV-predicted mortality score, number of comorbidities and ICU re-admissions. The ICU survivor HRQL was significantly lower compared with the normal population. Half of the patients did not return to their pre-hospital place of living, and numerous possible long-term complications were reported, particularly decreased tolerance, chronic fatigue and processing problems of relatives.

Conclusions

One-year mortality rate of long-term ICU-treated patient was 28 %, and this was predicted by age, disease severity, comorbidities and ICU re-admissions. The ICU survivors reported a lower HRQL, and a minority of these patients returned home directly after hospital discharge; however, GPs reported numerous possible long-term complications.

【 授权许可】

   
2015 Steenbergen et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Angus DC, Carlet J. Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med. 2003; 29:368-77.
• [2]Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med. 2011; 39:371-9.
• [3]Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003; 348:683-93.
• [4]Brinkman S, de Jonge E, Abu-Hanna A, Arbous MS, de Lange DW, de Keizer NF. Mortality after hospital discharge in ICU patients. Critical Care Med. 2013; 41:1229-36.
• [5]Wright JC, Plenderleith L, Ridley SA. Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia. 2003; 58:637-42.
• [6]Kaarlola A, Tallgren M, Pettila V. Long-term survival, quality of life, and quality-adjusted life-years among critically ill elderly patients. Crit Care Med. 2006; 34:2120-6.
• [7]Roch A, Wiramus S, Pauly V, Forel JM, Guervilly C, Gainnier M, et al. Long-term outcome in medical patients aged 80 or over following admission to an intensive care unit. Crit Care. 2011.
• [8]Mokart D, Etienne A, Esterni B, Brun JP, Chow-Chine L, Sannini A, Faucher M, Blache JL. Critically ill cancer patients in the ICU: short-term outcome and 1-year mortality. Acta Anaesthesiol Scand. 2012; 56:178-89.
• [9]Douglas SL, Daly BJ, Kelley CG, O’Toole E, Montenegro H. Chronically Critically ill patients: HRQOL and resource use after a disease management intervention. Am J Crit Care. 2007; 16:447-57.
• [10]Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, Sprangers MA, te Velde A, Verrips E. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998; 51:1055-68.
• [11]Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute Physiology and Chronic Health Evaluation (APACHE) IV: hospital mortality assessment for today’s critically ill patients. Crit Care Med. 2006; 34:1297-310.
• [12]Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996; 22:707-10.
• [13]Sandwijk. Licit and Illicit drug use in Amsterdam II. 1994.
• [14]Brinkman S, Bakhshi-Raiez F, Abu-Hanna A, de Jonge E, de Keizer NF. Determinants of mortality after hospital discharge in ICU patients: literature review and Dutch cohort study. Crit Care Med. 2013; 41:1237-51.
• [15]Keenan SP, Dodek P, Chan K, Hogg RS, Craib KJ, Anis AH, Spinelli JJ. Intensive care unit admission has minimal impact on long-term mortality. Crit Care Med. 2002; 30:501-7.
• [16]Williams TA, Dobb GJ, Finn JC, Knuiman MW, Geelhoed E, Lee KY, Webb SA. Determinants of long-term survival after intensive care. Crit Care Med. 2008; 36:1523-30.
• [17]Araujo I, Goncalves-Pereira J, Teixeira S, Nazareth R, Silvestre J, Mendes V, Tapadinhas C, Povoa P. Assessment of risk factors for in-hospital mortality after intensive care unit discharge. Biomarkers. 2012; 17:180-5.
• [18]Azoulay E, Adrie C, De Lassence A, Pochard F, Moreau D, Thiery G, Cheval C, Moine P, Garrouste-Org AC, Cohen Y, Timsit JF. Determinants of postintensive care unit mortality: a prospective multicenter study. Crit Care Med. 2003; 31:428-32.
• [19]Conti M, Merlani P, Ricou B. Prognosis and quality of life of elderly patients after intensive care. Swiss Med Wkly. 2012; 142:w13671.
• [20]Djaiani G, Ridley S. Outcome of intensive care in the elderly. Anaesthesia. 1997; 52:1130-6.
• [21]Wunsch H, Guerra C, Barnato AE, Angus DC, Li G, Linde-Zwirble WT. Three-year outcomes for medicare beneficiaries who survive intensive care. J Am Med Assoc. 2010; 303:849-56.
• [22]Dick A, Liu H, Zwanziger J, Perencevich E, Furuya EY, Larson E, Pogorzelska-Maziarz M, Stone PW. Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia. BMC Health Serv Res. 2012; 12:432. BioMed Central Full Text
• [23]Oeyen SG, Vandijck DM, Benoit DD, Annemans L, Decruyenaere JM. Quality of life after intensive care: a systematic review of the literature. Crit Care Med. 2010; 38:2386-400.
• [24]Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, Needham DM. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med. 2005; 31:611-20.
• [25]Welsh CH, Thompson K, Long-Krug S. Evaluation of patient-perceived health status using the Medical Outcomes Survey Short-Form 36 in an intensive care unit population. Crit Care Med. 1999; 27:1466-71.
• [26]Wehler M, Geise A, Hadzionerovic D, Aljukic E. Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Crit Care Med. 2003.
• [27]Williams TA, Leslie GD, Brearley L, Dobb GJ. Healthcare utilisation among patients discharged from hospital after intensive care. Anaesth Intensive Care. 2010; 38:732-9.
• [28]Lone NI, Seretny M, Wild SH, Rowan KM, Murray GD, Walsh TS. Surviving intensive care: a systematic review of healthcare resource use after hospital discharge*. Crit Care Med. 2013; 41:1832-43.
• [29]Addington-Hall J, Kalra L. Who should measure quality of life. Britisch Medical Journal. 2001; 9:1417-20.
• [30]Hofhuis JGM, Spronk PE, Stel HF, Schrijvers GJP, Rommes JH, Bakker J. The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay and after hospital discharge. Chest. 2008; 133:377-85.
• [31]Dinglas VD, Gellar J, Colantuoni E, Stan VA, Mendez-Tellez PA, Pronovost PJ, Needham DM. Does intensive care unit severity of illness influence recall of baseline physical function? J Crit Care. 2011; 26:634-7.
• [32]McPhail S, Haines T. Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients. Health Qual Life Outcomes. 2010; 8:65. BioMed Central Full Text
• [33]Gifford JM, Husain N, Dinglas VD, Colantuoni E, Needham DM. Baseline quality of life before intensive care: a comparison of patient versus proxy responses. Crit Care Med. 2010; 38:855-60.