Skip to main content

Advertisement

SpringerLink
Log in

Long-term outcome in ICU patients:

What about quality of life?

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

Analysis of mortality and quality of life (QOL) after intensive care unit (ICU) discharge.

Design

Prospective, observational study.

Setting

Mixed, 31-bed, medico-surgical ICU.

Patients

Consecutive adult ICU admissions between June 25 and September 10, 2000, except admissions for uncomplicated elective postoperative surveillance.

Interventions

None.

Measurements and results

Age, past history, admission APACHE II, SOFA score (admission, maximum, discharge), ICU and hospital mortality were recorded. A telephone interview employing the EuroQol 5D system was conducted 18 months after discharge. Of 202 patients, 34 (16.8%) died in the ICU and 23 (11.4%) died in the hospital after ICU discharge. Of the 145 patients discharged alive from hospital, 22 could not be contacted and 27 (13.4%) had died after hospital discharge. Of the 96 patients (47.5%) who completed the questionnaire, 38% had a worse QOL than prior to ICU admission, but only 8.3% were severely incapacitated. Twenty-three patients (24%) had reduced mobility, 15 (15.6%) had limited autonomy, 24 (25%) had alteration in usual daily activities, 29 (30.2%) expressed more anxiety/depression, and 42 (44%) had more discomfort or pain. Twenty-eight (62.2% of those who worked previously) patients had returned to work 18 months after ICU discharge.

Conclusions

Comparing QOL after discharge with that before admission, patients more frequently report worse QOL for the domains of pain/discomfort and anxiety/depression than for physical domains. Factors commonly associated with a change in QOL were previous problems in the affected domains, prolonged hospital length of stay (LOS), greater disease severity at admission and degree of organ dysfunction during ICU stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.

Similar content being viewed by others

References

  1. Heyland DK, Guyatt G, Cook DJ, Meade M, Juniper E, Cronin L, Gafni A (1998) Frequency and methodologic rigor of quality-of-life assessments in the critical care literature. Crit Care Med 26:591–598

    CAS  PubMed  Google Scholar 

  2. Sanders C, Egger M, Donovan J, Tallon D, Frankel S (1998) Reporting on quality of life in randomised controlled trials: bibliographic study. BMJ 317:1191–1194

    CAS  PubMed  Google Scholar 

  3. Oye RK, Bellamy PE (1991) Patterns of resource consumption in medical intensive care. Chest 99:685–689

    CAS  PubMed  Google Scholar 

  4. Detsky AS, Stricker SC, Mulley AG, Thibault GE (1981) Prognosis, survival and the expenditure of hospital resources for patients in an intensive-care unit. N Engl J Med 305:667–672

    CAS  PubMed  Google Scholar 

  5. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    CAS  PubMed  Google Scholar 

  6. Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter P, Sprung C, Colardyn FC, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med 26:1793–1800

    CAS  PubMed  Google Scholar 

  7. Lopes Ferreira F, Peres Bota D, Bross A, Melot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome. JAMA 286:1754–1758

    PubMed  Google Scholar 

  8. The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208

    PubMed  Google Scholar 

  9. Badia X, Diaz-Prieto A, Gorriz MT, Herdman M, Torrado H, Farrero E, Cavanilles JM (2001) Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit. Intensive Care Med 27:1901–1907

    Article  CAS  PubMed  Google Scholar 

  10. Garcia LF, Manzano Alonso JL, Gonzalez SB, Fuentes EJ, Saavedra SP (2000) [Survival and quality of life of patients with multiple organ failure one year after leaving an intensive care unit]. Med Clin (Barc) 114 Suppl 3:99–103

    Google Scholar 

  11. Reynolds HN, Haupt MT, Thill-Baharozian MC, Carlson RW (1988) Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA 260:3446–3450

    CAS  PubMed  Google Scholar 

  12. Pollack MM, Katz RW, Ruttiman UE, Getson PR (1988) Improving the outcome and efficiency of intensive care: the impact of an intensivist. Crit Care Med 16:11–17

    CAS  PubMed  Google Scholar 

  13. Brown JJ, Sullivan G (1989) Effect on ICU mortality of a full-time critical care specialist. Chest 96:127–129

    CAS  PubMed  Google Scholar 

  14. Carson SS, Stocking C, Podsadecki T, Christenson J, Pohlman A, MacRae S, Jordan J, Humphrey H, Siegler M, Hall J (1996) Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of "open" and "closed" formats. JAMA 276:322–328

    CAS  PubMed  Google Scholar 

  15. Metcalfe MA, Sloggett A, McPherson K (1997) Mortality among appropriately referred patients refused admission to intensive care units. Lancet 350:7-11

    CAS  PubMed  Google Scholar 

  16. Ghorra S, Reinert SE, Cioffi W, Buczko G, Simms HH (1999) Analysis of the effect of conversion from open to closed surgical intensive care unit. Ann Surg 229:163–171

    Article  CAS  PubMed  Google Scholar 

  17. Konopad E, Noseworthy TW, Johnston R, Shustack A, Grace M (1995) Quality of life measures before and one year after admission to an intensive care unit. Crit Care Med 23:1653–1659

    CAS  Google Scholar 

  18. Garcia Lizana F, Manzano Alonso JL (2001) Predicting factors of mortality after ICU discharge. Med Intensiva 25:179–186

    CAS  Google Scholar 

  19. Flaatten H, Kvale R (2001) Survival and quality of life 12 years after ICU. A comparison with the general Norwegian population. Intensive Care Med 27:1005–1011

    CAS  PubMed  Google Scholar 

  20. Dragsted L, Qvist L (1989) Outcome from intensive care. I. A 5-year study of 1308 patients: Short-term outcome. Eur J Anaesthesiol 6:131–144

    CAS  PubMed  Google Scholar 

  21. Dragsted L, Qvist J (1989) Outcome from intensive care. III. A 5-year study of 1308 patients: activity levels. Eur J Anaesthesiol 6:385–396

    CAS  PubMed  Google Scholar 

  22. Rosenberg AL, Watts C (2000) Patients readmitted to ICUs: a systematic review of risk factors and outcomes. Chest 118:492–502

    CAS  PubMed  Google Scholar 

  23. Udekwu P, Gurkin B, Oller D, Lapio L, Bourbina J (2001) Quality of life and functional level in elderly patients surviving surgical intensive care. J Am Coll Surg 193:245–249

    Article  CAS  PubMed  Google Scholar 

  24. Chelluri L, Grenvik A, Silverman M (1995) Intensive care for critically ill elderly: mortality, costs and quality of life. Review of the literature. Arch Intern Med 155:1013–1022

    CAS  PubMed  Google Scholar 

  25. Ip SP, Leung YF, Ip CY, Mak WP (1999) Outcomes of critically ill elderly patients: is high-dependency care for geriatric patients worthwhile? Crit Care Med 27:2351–2357

    Google Scholar 

  26. Rowan KM, Jenkinson C, Black N (2003) Health-related quality of life. In: Angus DC, Carlet J (eds) Surviving intensive care. Springer, Heidelberg pp 35–50

  27. Bergner M, Bobbitt RA, Carter WB, Gilson BS (1981) The Sickness Impact Profile: development and final revision of a health status measure. Med Care 19:787–805

    CAS  PubMed  Google Scholar 

  28. Hunt SM, McKenna SP, McEwen J, Williams J, Papp E (1981) The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med [A] 15:221–229

    Google Scholar 

  29. Fernandez RR, Cruz JJ, Mata GV (1996) Validation of a quality of life questionnaire for critically ill patients. Intensive Care Med 22:1034–1042

    PubMed  Google Scholar 

  30. Ware JJ, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    PubMed  Google Scholar 

  31. Richmond TS, Kauder D, Schwab CW (1998) A prospective study of predictors of disability at 3 months after non- central nervous system trauma. J Trauma 44:635–642

    CAS  PubMed  Google Scholar 

  32. Jones C, Griffiths RD, Macmillan RR, Palmer TEA (1994) Psychological problems occurring after intensive care. Br J Intensive Care 4:46–53

    Google Scholar 

  33. Tian ZM, Miranda DR (1995) Quality of life after intensive care with the sickness impact profile. Intensive Care Med 21:422–428

    CAS  PubMed  Google Scholar 

  34. Hurel D, Loirat P, Saulnier F, Nicolas F, Brivet F (1997) Quality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale. Intensive Care Med 23:331–337

    Article  CAS  Google Scholar 

  35. Ridley SA, Chrispin PS, Scotton H, Rogers J, Lloyd D (1997) Changes in quality of life after intensive care: comparison with normal data. Anaesthesia 52:195–202

    CAS  PubMed  Google Scholar 

  36. Capuzzo M, Grasselli C, Carrer S, Gritti G, Alvisi R (2000) Validation of two quality of life questionnaires suitable for intensive care patients. Intensive Care Med 26:1296–1303

    Article  CAS  PubMed  Google Scholar 

  37. Vazquez MG, Rivera FR, Gonzalez CA, Delgado-Rodriguez M, Torres Ruiz JM, Raya PA, Aguayo DH (1992) Factors related to quality of life 12 months after discharge from an intensive care unit. Crit Care Med 20:1257–1262

    Google Scholar 

  38. Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA (1997) Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire. Anaesthesia 52:15–23

    CAS  PubMed  Google Scholar 

  39. Heyland DK, Hopman W, Coo H, Tranmer J, McColl MA (2000) Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life. Crit Care Med 28:3599–3605

    CAS  PubMed  Google Scholar 

  40. Badia X, Diaz-Prieto A, Rue M, Patrick DL (1996) Measuring health and health state preferences among critically ill patients. Intensive Care Med 22:1379–1384

    Article  CAS  Google Scholar 

  41. Granja C, Teixeira-Pinto A, Costa-Pereira A (2002) Quality of life after intensive care—evaluation with EQ-5D questionnaire. Intensive Care Med 28:898–907

    Article  Google Scholar 

  42. Sage WM, Rosenthal MH, Silverman JF (1986) Is intensive care worth it? An assessment of input and outcome for the critically ill. Crit Care Med 14:777–782

    CAS  PubMed  Google Scholar 

  43. Brooks R, Kerridge R, Hillman K, Bauman A, Daffurn K (1997) Quality of life outcomes after intensive care. Comparison with a community group. Intensive Care Med 23:581–586

    Article  CAS  PubMed  Google Scholar 

  44. Badia X, Schiaffino A, Alonso J, Herdman M (1998) Using the EuroQoI 5-D in the Catalan general population: feasibility and construct validity. Qual Life Res 7:311–322

    CAS  PubMed  Google Scholar 

  45. Rivera-Fernandez R, Vazquez-Mata G, Bravo M, Aguayo-Hoyos E, Zimmerman J, Wagner D, Knaus W (1998) The Apache III prognostic system: customized mortality predictions for Spanish ICU patients. Intensive Care Med 24:574–581

    Google Scholar 

  46. Pettila V, Kaarlola A, Makelainen A (2000) Health-related quality of life of multiple organ dysfunction patients one year after intensive care. Intensive Care Med 26:1473–1479

    CAS  PubMed  Google Scholar 

  47. Jacobs CJ, Van der Vliet JA, Roozendaal MT, Van der Linden CJ (1988) Mortality and quality of life after intensive care for critical illness. Intensive Care Med 14:217–220

    CAS  PubMed  Google Scholar 

  48. Barie PS, Hydo LJ, Fischer E (1996) Utility of illness severity scoring for prediction of prolonged surgical critical care. J Trauma 40:513–518

    CAS  PubMed  Google Scholar 

  49. Zaren B, Hedstrand U (1987) Quality of life among long-term survivors of intensive care. Crit Care Med 15:743–747

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070 , Brussels, Belgium

    Francisca García Lizana, Daliana Peres Bota, Michael De Cubber & Jean-Louis Vincent

Authors
  1. Francisca García Lizana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daliana Peres Bota
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael De Cubber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-Louis Vincent
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Louis Vincent.

Appendix

Appendix

Questionnaire sent by mail when telephone contact was not possible

A. For each section, note the number that best relates to your situation 1 month before hospital admission and your situation now

 

Previous

Current

Mobility (M)

  1. I have no problems in walking about

_______

_______

  2. I have some problems in walking about

_______

_______

  3. I am confined to bed

_______

_______

Autonomy (A)

  1. I have no problems with self-care. Complete autonomy

_______

_______

  2. I have some problems washing or dressing myself

_______

_______

  3. I am unable to wash or dress myself

_______

_______

Usual activities (UA)

  1. I have no problems performing my usual activities (e.g. work, studies, housework, family or leisure activities)

_______

_______

  2. I have some problems performing my usual activities

_______

_______

  3. I am unable to perform my usual activities

_______

_______

Pain/discomfort (PD)

  1. I have no pain or discomfort

_______

_______

  2. I have moderate pain or discomfort

_______

_______

  3. I have extreme pain or discomfort

_______

_______

Anxiety/depression (AD)

  1. I am not anxious or depressed

_______

_______

  2. I am moderately anxious or depressed

_______

_______

  3. I am extremely anxious or depressed

_______

_______

Compared with my general level of health 1 month before hospital admission, my state today is

  1.

Better

 

  2.

Much the same

 

  3.

Worse

 

B. Of the following work situations, indicate your current status and your status prior to admission in the ICU

Prior to admission

Current

  a. Retired or permanently disabled

  a. Retired or permanently disabled

  b. Temporarily incapacitated

  b. Temporarily incapacitated

  c. Employed

  c. Employed

Rights and permissions

Reprints and permissions

About this article

Cite this article

García Lizana, F., Peres Bota, D., De Cubber, M. et al. Long-term outcome in ICU patients:. Intensive Care Med 29, 1286–1293 (2003). https://doi.org/10.1007/s00134-003-1875-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-1875-z

Keywords

Search

Navigation