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Long-term outcome and functional health status following intensive care in Hong Kong
T G Short1, T A Buckley, M Y Rowbottom
1Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin.
Objectives:
To assess mortality and functional health status of patients at 1 yr following admission to a multidisciplinary intensive care unit (ICU) in Hong Kong. To determine which factors are associated with a poor long-term outcome.
Design:
Prospective data collection and review.
Setting:
A 14-bed multidisciplinary ICU in a 1,400-bed tertiary care university hospital.
Patients:
Data from 2,268 consecutive patients admitted over a 2.5-yr period was analyzed, including follow-up at 1 yr in 853 adult survivors.
Interventions:
None.
Measurements And Main Results:
The patients' clinical details and Acute Physiology and Chronic Health Evaluation (APACHE) II scores were recorded on day 2 of admission and reviewed at time of discharge or death. The mean APACHE II score on admission was 18. Survival status at 1 yr was ascertained and the sickness impact profile (SIP) scored as a measure of functional health status for survivors. Sixty-five percent of patients survived to discharge from hospital and 44% of patients were known to survive to 1 yr; 6% of patients could not be traced at 1 yr. Functional health status was assessed in 85% of eligible adult patients. Survivors to 1 yr were younger than nonsurvivors and had lower APACHE II scores. The median SIP score was 5.1, (25th and 75th percentiles: 0 to 15), and 76% of patients had SIP scores < or = 15, i.e., normal health to moderate disability. Five percent of the patients were not working or had retired for health-related reasons. Stepwise logistic regression to identify factors associated with poor functional health status defined as a SIP score >15 at 1 yr found increasing age, cardiac/ respiratory arrest, intracranial hemorrhage, and trauma to be associated with poor outcomes. A correlation was found between APACHE II scores and SIP scores (Spearman's correlation coefficient = 0.13, p < .001).
Conclusions:
The SIP scores indicated that the majority of patients who survived to 1 yr after ICU admission enjoyed reasonable functional health status. A poor functional health status at 1 yr did not relate to the severity of the acute illness suffered, but appeared to relate to the prognosis of the underlying disease process.