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Risk factors for worsened quality of life in patients on mechanical ventilation. A prospective multicenter study
M Busico1, D Intile2, M Sívori3
1Unidad de Terapia Intensiva, Clínica Olivos SMG, Buenos Aires, Argentina.
Objective:
To identify risk factors for worsened quality of life (QoL) and activities of daily living (ADL) at 3 and 12 months after discharge from the Intensive Care Unit (ICU) in patients on mechanical ventilation (MV).
Design:
A prospective, multicentric observational study was made.
Setting:
Three ICUs in Argentina.
Patients:
The study included a total of 84 out of 129 mainly clinical patients admitted between 2011-2012 and requiring over 24hours of MV.
Interventions:
No interventions were carried out.
Variables:
Quality of life was assessed with the EQ-5D (version for Argentina), and ADL with the Barthel index.
Results:
The EQ-5D and Barthel scores were assessed upon admission to the ICU (baseline) and after three months and one year of follow-up. Comorbidities, delirium, ICU acquired weakness (ICUAW), and medication received were daily assessed during ICU stay. The baseline QoL of the global sample showed a median index of [0.831 (IQR25-75% 0.527-0.931)], versus [0.513 (IQR0.245-0.838)] after three months and [0.850 (IQR0.573-1.00)] after one year. Significant differences were observed compared with QoL in the Argentinean general population [mean 0.880 (CI 0.872-0.888), p<0.001; p<0.001; p0.002]. Individual analysis showed that 67% of the patients had worsened their QoL at three months, while 33% had recovered their QoL. In the multivariate analysis, the variables found to be independent predictors of worsened QoL were a hospital stay ≥21 days [OR 12.57 (2.75-57.47)], age ≥50 years [OR 5.61 (1.27-24.83)], previous poor QoL [OR 0.11 (0.02-0.54)] and persistent ICUAW [OR 8.32 (1.22-56.74)]. Similar results were found for the worsening of ADL.
Conclusions:
Quality of life is altered after critical illness, and its recovery is gradual over time. Age, length of hospital stay, previous QoL and persistent ICUAW seem to be risk factors for worsened QoL.
Insights
Intensive Care Unit survivors often experience reduced quality of life and daily living abilities. Key risk factors for worsened outcomes include longer hospital stays, older age, and persistent ICU-acquired weakness.
Area of Science:
- Critical Care Medicine
- Rehabilitation Medicine
- Health Outcomes Research
Background:
- Intensive Care Unit (ICU) survivors frequently face long-term challenges impacting their quality of life (QoL) and activities of daily living (ADL).
- Identifying predictors of poor recovery is crucial for targeted interventions and improved patient outcomes post-ICU discharge.
Purpose of the Study:
- To determine risk factors associated with diminished QoL and ADL at 3 and 12 months post-ICU discharge.
- To analyze predictors of worsened QoL and ADL in patients requiring mechanical ventilation (MV).
Main Methods:
- Prospective, multicentric observational study involving 84 adult patients requiring over 24 hours of mechanical ventilation.
- QoL assessed using the EQ-5D and ADL using the Barthel index at baseline, 3 months, and 12 months post-discharge.
- Data on comorbidities, delirium, ICU-acquired weakness (ICUAW), and medications were collected during ICU stay.
Main Results:
- A significant decline in QoL was observed at 3 months post-ICU discharge compared to baseline and the general population, with partial recovery by 12 months.
- Independent predictors of worsened QoL included longer hospital stay (≥21 days), older age (≥50 years), pre-existing poor QoL, and persistent ICUAW.
- Similar risk factors were identified for the worsening of ADL.
Conclusions:
- Critical illness significantly alters patient QoL, with recovery being a gradual process.
- Age, prolonged hospital stay, baseline QoL, and persistent ICUAW are identified as key risk factors for adverse long-term QoL outcomes in ICU survivors requiring MV.
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