The Impact of Critical Illness on Perceived Health-Related Quality of Life During ICU Treatment, Hospital Stay, and After Hospital Discharge: A Long-term Follow-up Study

doi:10.1378/chest.07-1217

Chest

Volume 133, Issue 2, February 2008, Pages 377-385

https://doi.org/10.1378/chest.07-1217 Get rights and content

Background

The time course of changes in health-related quality of life (HRQOL) following discharge from the ICU and during a general ward stay has not been studied. We therefore studied the immediate impact of critical illness on HRQOL and its recovery over time.

Methods

In a prospective study, all patients admitted to the ICU for > 48 h who ultimately survived to follow-up at 6 months were included. The Medical Outcomes Study 36-item short form was used to measure HRQOL before ICU admission, at discharge from the ICU and hospital, and at 3 and 6 months following discharge from the ICU and hospital. An age-matched healthy Dutch population was used as a reference.

Results

Of the 451 included patients, 252 could be evaluated at 6 months (40 were lost to follow-up, and 159 died). Pre-ICU admission HRQOL in survivors was significantly worse compared to the healthy population. Patients who died between ICU admission and long-term follow-up had significantly worse HRQOL in all dimensions already at ICU admission when compared to the long-term survivors. HRQOL decreased in all dimensions (p < 0.001) during ICU stay followed by a rapid improvement during hospital stay, gradually improving to near pre-ICU admission HRQOL at 6 months following ICU discharge. Physical functioning (PF), general health (GH), and social functioning (SF) remained significantly lower than pre-ICU admission values. Compared to the healthy Dutch population, ICU survivors had significantly lower HRQOL 6 months following ICU discharge (except for the bodily pain score).

Conclusions

A sharp multidimensional decline in HRQOL occurs during ICU admission where recovery already starts following ICU discharge to the general ward. Recovery is incomplete for PF, GH, and SF when compared to baseline values and the healthy population.

Section snippets

Materials and Methods

All patients admitted for > 48 h to a 10-bed closed-format mixed surgical-medical ICU of a 654-bed university-affiliated hospital in the Netherlands were eligible for the study. Between September 2000 and April 2004, all 2,127 patients admitted to the ICU were screened for study participation (Fig 1). In patients readmitted to the ICU (n = 36), data on HRQOL at discharge from the final ICU admission were included in the study. All patients surviving the 6-month follow-up period were included in

Results

Of the 2,127 patients screened, 1,676 patients were excluded (Fig 1). Of these excluded patients, 179 died while in the ICU (10.7%) and 87 died while on the general ward (5.2%). In the 451 patients included in the study, HRQOL was measured on ICU admission, and in 252 patients at the 6-month follow-up. At that time, 159 patients had died and 40 patients (9%) were lost to follow-up (Fig 1). The demographic and clinical characteristics of the patients lost to follow-up did not differ from the

Discussion

Both the change in HRQOL during ICU admission and its immediate recovery following ICU discharge have never been studied. This long-term prospective study evaluated the impact of critical illness on the perceived HRQOL in patients admitted to the ICU for > 48 h and surviving up to 6 months following ICU discharge. Before ICU admission, HRQOL was already impaired when compared to the healthy population. This was even more pronounced in the nonsurvivors. Critical illness caused a significant drop

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Cited by (147)

Body composition and muscle strength at the end of ICU stay are associated with 1-year mortality, a prospective multicenter observational study
2023, Clinical Nutrition
After a prolonged intensive care unit (ICU) stay patients experience increased mortality and morbidity. The primary aim of this study was to assess the prognostic value of nutritional status, body mass composition and muscle strength, as assessed by body mass index (BMI), bioelectrical impedance analysis (BIA), handgrip (HG) test, and that of the biological features to predict one-year survival at the end of a prolonged ICU stay.
This was a multicenter prospective observational study. Survivor patients older than 18 years with ICU length of stay >72 h were eligible for inclusion. BIA and HG were performed at the end of the ICU stay. Malnutrition was defined by BMI and fat-free mass index (FFMI). The primary endpoint was one-year mortality. Multivariable logistic regression was performed to determine parameters associated with mortality.
572 patients were included with a median age of 63 years [53.5; 71.1], BMI of 26.6 kg/m² [22.8; 31.3], SAPS II score of 43 [31; 58], and ICU length of stay of 9 days [6; 15]. Malnutrition was observed in 142 (24.9%) patients. During the 1-year follow-up after discharge, 96 (18.5%) patients died. After adjustment, a low HG test score (aOR = 1.44 [1.11; 1.89], p = 0.01) was associated with 1-year mortality. Patients with low HG score, malnutrition, and Albuminemia <30 g/L had a one-year death rate of 41.4%. Conversely, patients with none of these parameters had a 1-year death rate of 4.1%.
BIA to assess FFMI, HG and albuminemia at the end of ICU stay could be used to predict 1-year mortality. Their ability to identify patients eligible for a structured recovery program could be studied.
Reduced quality of life in ICU survivors - the story behind the numbers: A mixed methods study
2021, Journal of Critical Care
To gain insight into the daily functioning of ICU survivors who reported a reduced quality of life (QoL) one year after ICU admission.
A two-phase mixed method study design. QoL was assessed using the SF-36 questionnaire before admission and after one year (Phase 1). Participants reporting a reduced QoL were invited for an in-depth interview (Phase 2). Interview data were coded thematically using the PROMIS framework.
Of the 797 participants, 173 (22%) reported a reduced QoL, of which 19 purposively selected patients were interviewed. In line with their questionnaire scores, most participants described their QoL as reduced. They suffered from physical, mental and/or cognitive problems, impacting their daily life, restricting hobbies, work, and social activities. A new balance in life, including relationships, had to be found. Some interviewees experienced no changes in their QoL; they were grateful for being alive, set new life priorities, and were able to accept their life with its limitations.
Reduction in QoL is due to physical, mental, and cognitive health problems, restricting participants what they want to do. However, QoL was not only affected by the critical illness, but also by factors including independency, comorbidity, and life events.
Registration: NCT03246334 (clinical trials.gov).
Relationship between intensive care unit-acquired weakness, fatigability and fatigue: What role for the central nervous system?
2021, Journal of Critical Care
To provide a comprehensive review of studies that have investigated fatigue in intensive care unit (ICU) survivors and questions the potential link between intensive care unit-acquired weakness (ICUAW), fatigability and fatigue. We also question whether the central nervous system (CNS) may be the link between these entities.
A narrative review of the literature that investigated fatigue in ICU survivors and review of clinical trials enabling understanding of CNS alterations in response to ICU stays.
Fatigue is a pervasive and debilitating symptom in ICU survivors that can interfere with rehabilitation. Due to the complex pathophysiology of fatigue, more work is required to understand the roles of ICUAW and/or fatigability in fatigue to provide a more holistic understanding of this symptom. While muscle alterations have been well documented in ICU survivors, we believe that CNS alterations developing early during the ICU stay may play a role in fatigue.
Fatigue should be considered and treated in ICU survivors. The causes of fatigue are likely to be specific to the individual. Understanding the role that ICUAW and fatigability may have in fatigue would allow to tailor individual treatment to prevent this persistent symptom and improve quality of life.
Effect of non-sedation on physical function in survivors of critical illness - A substudy of the NONSEDA randomized trial
2021, Journal of Critical Care
Critical illness impairs physical function. The NONSEDA trial was a multicenter randomized trial, assessing non-sedation versus sedation during mechanical ventilation. The aim of this sub-study was to assess the effect of non-sedation on physical function.
All patients from one NONSEDA trial site were included. At ICU discharge and three months thereafter, survivors were assessed for physical function.
205 patients were included, 118 survived to follow-up, 116 participated (98%). Primary outcome: Three months after ICU-discharge, health-related quality of life (SF-36, physical component score) was similar (non-sedated 38.3 vs sedated 36.6, mean difference 1.7, 95% CI -1.7 to 5.1), as was function in activities of daily living (Barthel Index, non-sedated 19.5 vs sedated 18, median difference 1.5, 95% CI -0.2 to 3.2). Secondary outcomes: Non-sedated patients had a better Barthel Index at ICU-discharge (median 9 vs 4, median difference 5, 95% CI 2.5 to 7.5). At three months post-ICU discharge, the two groups did not differ regarding handgrip strength, walking distance, muscle size or biomechanical data.
Non-sedation did not lead to improved quality of life regarding physical function or better function in activities of everyday living. Non-sedated patients had a better physical recovery at ICU discharge.
Clinicaltrials.gov NCT02034942, registered January 14., 2014.
Quality of life assessment following amputation for septic shock: a long-term descriptive survey after symmetric peripheral gangrene
2019, Journal of Critical Care
To assess health-related quality of life (HRQOL) following rehabilitation of amputees suffering symmetric peripheral gangrene (SPG) after septic shock.
A retrospective cohort study was conducted in nine French specialized rehabilitation centers. Thirty-two ICU adult patients hospitalized between 2005 and 2015 for septic shock who additionally presented with SPG resulting in at least two major amputations were enrolled. HRQOL was assessed by EQ-5D-3 L questionnaire.
All patients (mean ICU length of stay 39 ± 22d, SAPS II 58 ± 18) had both lower limbs amputated and 84% were quadruple amputees. HRQOL, assessed 4.8 ± 2.8 years after amputation, was inferior to the French reference. However, patients' self-rated health status was similar to the reference at the time of HRQOL assessment. The main factor of impaired HRQOL was intense phantom pain, not the mobility or self-care dimensions of EQ-5D. All patients except one preferred to be treated again for SPG despite disability.
ICU survivors referred to rehabilitation centers after SPG-related amputations had impaired HRQOL. At the time of HRQOL assessment, they considered themselves in good health and preferred to be treated again despite disability. Appraisal of long-term functional outcome should not be used to guide end-of-life decision-making in this situation.
Supporting the Geriatric Critical Care Patient: Decision Making, Understanding Outcomes, and the Role of Palliative Care
2019, Anesthesiology Clinics

View all citing articles on Scopus

This study was designed and started at the Gelre Hospital in Apeldoorn at the time that Dr. Bakker was still working there.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Chest

Original ResearchQuality of LifeThe Impact of Critical Illness on Perceived Health-Related Quality of Life During ICU Treatment, Hospital Stay, and After Hospital Discharge: A Long-term Follow-up Study

Background

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Quality of life following critical care: moving beyond survival

Intensive Care Med

Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients

Crit Care Med

Long-term outcomes in survivors from critical illness

Anaesthesia

Surviving intensive care: a report from the 2002 Brussels Roundtable

Intensive Care Med

Reliability of the next of kins' estimates of critically ill patients' quality of life

Anaesthesia

Frequency and methodologic rigor of quality-of-life assessments in the critical care literature

Crit Care Med

Quality of life before and after intensive care

Anaesthesia

Long-term outcome in ICU patients: what about quality of life?

Intensive Care Med

Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population

Crit Care Med

Changes in quality of life after medical intensive care

Intensive Care Med

Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome

Am J Respir Crit Care Med

Understanding the treatment preferences of seriously ill patients

N Engl J Med

Informed consent in clinical trials in critical care: experience from the PAC-Man Study

Intensive Care Med

Quality of life on admission to the intensive care: can we query the relatives?

Intensive Care Med

Translation, validation, and norming of the Dutch language version of the SF-36 health survey in community and chronic disease populations

J Clin Epidemiol

Validating the SF-36 health survey questionnaire: new outcome measure for primary care

BMJ

Short form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire

Anaesthesia

Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study

Med Care

Original Research
Quality of Life
The Impact of Critical Illness on Perceived Health-Related Quality of Life During ICU Treatment, Hospital Stay, and After Hospital Discharge: A Long-term Follow-up Study