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Quality of life in the five years after intensive care: a cohort study.

Cuthbertson BH, Roughton S, Jenkinson D, Maclennan G, Vale L - Crit Care (2010)

Bottom Line: During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001).Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge.In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada. brian.cuthbertson@sunnybrook.ca

ABSTRACT

Introduction: Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge.

Methods: A prospective longitudinal cohort study in a University Hospital in the UK. Quality of life was assessed from the period before ICU admission until 5 years and quality adjusted life years calculated.

Results: 300 level 3 intensive care patients of median age 60.5 years and median length of stay 6.7 days, were recruited. Physical quality of life fell to 3 months (P = 0.003), rose back to pre-morbid levels at 12 months then fell again from 2.5 to 5 years after intensive care (P = 0.002). Mean physical scores were below the population norm at all time points but the mean mental scores after 6 months were similar to those population norms. The utility value measured using the EuroQOL-5D quality of life assessment tool (EQ-5D) at 5 years was 0.677. During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001).

Conclusions: Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support.

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Kaplan-Meier survival estimates for study patients who were available for follow up over the five years after ICU discharge (solid line). Patients are censored throughout period due to loss to follow up. Age- and sex-matched survival for UK general population is also shown (dotted line). ICU = intensive care unit.
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Figure 2: Kaplan-Meier survival estimates for study patients who were available for follow up over the five years after ICU discharge (solid line). Patients are censored throughout period due to loss to follow up. Age- and sex-matched survival for UK general population is also shown (dotted line). ICU = intensive care unit.

Mentions: Table 1 shows baseline demographics and outcomes for enrolled patients versus all general ICU patients for the same period (May 2001 to April 2002). Figure 1 shows the study recruitment and retention, death rates and loss to follow up at each time point up to five years. Due to the requirement of the ethics committee no data is available on the patients who refused consent. Figure 2 shows a Kaplan-Meier survival estimate for study patients. The independent predictors of death in this cohort were age (> 64 vs ≤ 64 years, hazard ratio (HR), 2.09, 95% confidence interval (CI) 1.37-3.17), APACHE II (> 18 vs ≤ 18 HR 1.99, 95% CI 1.28-3.11); ICU length of stay (> 2 vs ≤ 2 days HR 1.74, 95% CI 1.15-2.63); premorbid physical component score (increase in one physical component score point, HR 0.984, 95% CI 0.970-0.997) and premorbid mental component score (increase in one mental component score point HR 0.973, 95% CI 0.957-0.989).


Quality of life in the five years after intensive care: a cohort study.

Cuthbertson BH, Roughton S, Jenkinson D, Maclennan G, Vale L - Crit Care (2010)

Kaplan-Meier survival estimates for study patients who were available for follow up over the five years after ICU discharge (solid line). Patients are censored throughout period due to loss to follow up. Age- and sex-matched survival for UK general population is also shown (dotted line). ICU = intensive care unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875518&req=5

Figure 2: Kaplan-Meier survival estimates for study patients who were available for follow up over the five years after ICU discharge (solid line). Patients are censored throughout period due to loss to follow up. Age- and sex-matched survival for UK general population is also shown (dotted line). ICU = intensive care unit.
Mentions: Table 1 shows baseline demographics and outcomes for enrolled patients versus all general ICU patients for the same period (May 2001 to April 2002). Figure 1 shows the study recruitment and retention, death rates and loss to follow up at each time point up to five years. Due to the requirement of the ethics committee no data is available on the patients who refused consent. Figure 2 shows a Kaplan-Meier survival estimate for study patients. The independent predictors of death in this cohort were age (> 64 vs ≤ 64 years, hazard ratio (HR), 2.09, 95% confidence interval (CI) 1.37-3.17), APACHE II (> 18 vs ≤ 18 HR 1.99, 95% CI 1.28-3.11); ICU length of stay (> 2 vs ≤ 2 days HR 1.74, 95% CI 1.15-2.63); premorbid physical component score (increase in one physical component score point, HR 0.984, 95% CI 0.970-0.997) and premorbid mental component score (increase in one mental component score point HR 0.973, 95% CI 0.957-0.989).

Bottom Line: During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001).Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge.In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada. brian.cuthbertson@sunnybrook.ca

ABSTRACT

Introduction: Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge.

Methods: A prospective longitudinal cohort study in a University Hospital in the UK. Quality of life was assessed from the period before ICU admission until 5 years and quality adjusted life years calculated.

Results: 300 level 3 intensive care patients of median age 60.5 years and median length of stay 6.7 days, were recruited. Physical quality of life fell to 3 months (P = 0.003), rose back to pre-morbid levels at 12 months then fell again from 2.5 to 5 years after intensive care (P = 0.002). Mean physical scores were below the population norm at all time points but the mean mental scores after 6 months were similar to those population norms. The utility value measured using the EuroQOL-5D quality of life assessment tool (EQ-5D) at 5 years was 0.677. During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001).

Conclusions: Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support.

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