Intensive Care Medicine

, Volume 32, Issue 11, pp 1832–1838 | Cite as

Predictors of early recovery of health status after intensive care

  • Maurizia CapuzzoEmail author
  • Rui P. Moreno
  • Barbara Jordan
  • Peter Bauer
  • Raffaele Alvisi
  • Philipp G. H. Metnitz



To identify factors predictive of good or poor recovery of health status and health-related quality of life (HRQOL) 90 days after admission to an intensive care unit (ICU).

Design and setting

Prospective international multicentre study in 19 ICUs participating in the HRQOL substudy of the SAPS 3 project.


The EuroQol questionnaire (EQ) was administered to discharged ICU patients 90 days after admission. A question to compare present health status with that 3 months before ICU admission (same/better/worse) was added.


Six hundred and eighteen patients who spent > 24 h in an ICU and survived for 90 days. EQ data and health comparison were available in 559 (90.5%) of them.

Measurements and results

Patients reported their general level of health to be better (33.8%), the same (31.1%), or worse (35.1%) in comparison with baseline. Recovery was considered to be good for answers “better” or “the same”. Regression analysis showed that transplantation surgery [odds ratio (OR) 0.07, 95% confidence interval (CI) 0.01–0.63], coronary artery bypass surgery without valvular repair (OR 0.39, 95% CI 0.17–0.92) and being admitted to the ICU from a ward or other location (OR 0.55, 95% CI 0.31–0.95) predicted good recovery of health. Predictors of poor recovery (all present at the time of ICU admission) were unplanned ICU admission, hypothermia, serum creatinine level ≥ 2 mg/dl, pH ≤ 7.25 and metastatic cancer.


More than 60% of ICU patients report good recovery of their health 90 days after ICU admission, depending on their illness and circumstances of ICU admission.


Health status Quality of life Intensive care Critical care Outcome 



The SAPS 3 project was endorsed in June 2002 by the European Society of Intensive Care Medicine (ESICM). It received support from the Austrian Centre for Documentation and Quality Assurance in Intensive Care Medicine (ASDI), the Portuguese Society of Intensive Care (SPCI), and the Medical Economics and Research Centre in Sheffield, UK. An unrestricted educational grant from Merck Sharp & Dohme Portugal to the SPCI funded the installation of the Coordination and Communication Centre in Lisbon. iMDsoft (Tel Aviv, Israel), developed and provided free of charge, was the Internet-based data collection software. Statistical analysis was supported by a grant from the Fund of the Austrian National Bank, project 10995 ONB. We thank Eduardo Almeida, who developed the SAPS 3 stand-alone database system, including the variables used in the present substudy. We are grateful to the participating ICUs who made this project possible. We also thank the EuroQol group, who gave us permission to use EQ-5D and provided the appropriate language versions free of charge.

Supplementary material

134_2006_307_MOESM1_ESM.rtf (143 kb)
Electronic Supplementary Material (RTF 144K)


  1. 1.
    Consensus Conference organised by the ESICM and the SRLF (1994) Predicting outcome in ICU patients. Intensive Care Med 20:390–397CrossRefGoogle Scholar
  2. 2.
    Angus DC, Carlet J on behalf of the 2002 Brussels Roundtable Participants (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377 DOI 10.1007/s00134-002-1624-8PubMedGoogle Scholar
  3. 3.
    Curtis JR (2003) Measuring health status after critical illness: where are we and where do we go from here? In: Angus DC, Carlet J (ed) Surviving intensive care. update in intensive care medicine. Springer, Berlin Heidelberg New York, pp 181–196Google Scholar
  4. 4.
    Metnitz PGH, Moreno RP, Almeida E, Jordan B, Bauer P, Abizanda Campos R, Iapichino G, Edbrooke D, Capuzzo M, Le Gall J-R, on behalf of the SAPS 3 Investigators (2005) SAPS 3 – from evaluation of the patient to evaluation of the ICU. Part 1. Objectives, methods and cohort description. Intensive Care Med 31:1336–1344 DOI 10.1007/s00134-005-2762-6PubMedCrossRefGoogle Scholar
  5. 5.
    Moreno RP, Metnitz PGH, Almeida E, Jordan B, Bauer P, Abizanda Campos R, Iapichino G, Edbrooke D, Capuzzo M, Le Gall J-R, on behalf of the SAPS 3 Investigators (2005) SAPS 3 – from evaluation of the patient to evaluation of the ICU. Part 2. Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 31:1345–1355 DOI 10.1007/s00134-005-2763-5PubMedCrossRefGoogle Scholar
  6. 6.
    The EuroQol Group. (1990) EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 16:199–208CrossRefGoogle Scholar
  7. 7.
    Brazier J, Jones N, Kind P (1993) Testing the validity of the EuroQol and comparing it with the SF health survey questionnaire. Qual Life Res 2:169–180PubMedCrossRefGoogle Scholar
  8. 8.
    Van Agt H, Essink-Bot M-L, Krabbe P, Bonsel G (1994) Test – retest reliability of health state valuations collected with the EuroQol questionnaire. Soc Sci Med 39:1537–1544PubMedCrossRefGoogle Scholar
  9. 9.
    Kind P, Dolan P, Gudex C, Williams A (1998) Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 316:736–741PubMedGoogle Scholar
  10. 10.
    Badia X, Diaz-Prieto A, Rue M, Patrick DL (1996) Measuring health and health state preferences among critically ill patients. Intensive Care Med 22:1379–1384PubMedCrossRefGoogle Scholar
  11. 11.
    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 DOI 10.1007/s00134-001-1137-xPubMedCrossRefGoogle Scholar
  12. 12.
    Garcia Lizana F, Peres Bota D, De Cubber M, Vincent J-L (2003) Long-term outcome in ICU patients: What about quality of life? Intensive Care Med 29:1286–1293 DOI 10.1007/s00134-003-1875-zCrossRefGoogle Scholar
  13. 13.
    Kaarlola A, Pettila V, Kekki P (2004) Performance of two measures of general health-related quality of life, the EQ-5D and the RAND-36 among critically ill patients. Intensive Care Med 30:2245–2252 DOI 10.1007/s00134-004-2471-6PubMedCrossRefGoogle Scholar
  14. 14.
    Orwelius L, Nordlund A, Edéll-Gustafsson U, Simonsson E, Nordlund P, Kristenson M, Bendtsen P, Sjöberg (2005) Role of pre-existing disease in patients' perceptions of health-related quality of life after intensive care. Crit Care Med 33:1557–1564PubMedCrossRefGoogle Scholar
  15. 15.
    Brooks R with the EuroQol Group (1996) EuroQol: the current state of play. Health Policy 37:53–72PubMedCrossRefGoogle Scholar
  16. 16.
    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 DOI 10.1007/s00134-002-1345-zPubMedCrossRefGoogle Scholar
  17. 17.
    Needham DM, Dowdy DW, Mendez-Tellez PA, Herridge MS, Pronovost PJ (2005) Studying outcomes of intensive care unit survivors: measuring exposures and outcomes. Intensive Care Med 31:1153–1160 DOI 10.1007/s00134-005-2656-7Google Scholar
  18. 18.
    Ridley SA, Chrispin PS, Scotton H, Rogers J, Lloyd D (1997) Changes in quality of life after intensive care: comparison with normal data. Anaesthesia 52:195–202PubMedCrossRefGoogle Scholar
  19. 19.
    Wehler M, Geise A, Hadzionerovic D, Aljukic E, Reulbach U, Hahn EG, Strauss R (2003) Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Crit Care Med 31:1094–1101PubMedCrossRefGoogle Scholar
  20. 20.
    Vazquez Mata G, Rivera Fernandez R, Gonzales Carmona A, Delgado-Rodriguez M, Torres Ruiz JM, Raya Pugnaire A, Aguayo de Hoyos E (1992) Factors related to quality of life 12 months after discharge from an intensive care unit. Crit Care Med 20:1257–1262CrossRefGoogle Scholar
  21. 21.
    Roset M, Badia X, Mayo NE (1999) Sample size calculations in studies using EuroQol 5 D. Qual Life Res 8:539–549PubMedCrossRefGoogle Scholar
  22. 22.
    Artinian NT, Duggan C, Miller P (1993) Age differences in patient recovery patterns following coronary artery bypass surgery. Am J Crit Care 2:453–461PubMedGoogle Scholar
  23. 23.
    Schulz P, Zimmerman L, Barnason S, Nieveen J (2005) Gender differences in recovery after coronary artery bypass graft surgery. Prog Cardiovasc Nurs 20:58–64PubMedGoogle Scholar
  24. 24.
    Lindquist R, Dupuis G, Terrin ML, Hoogwerf B, Czajkowski S, Herd JA, Barton FB, Tracy MF, Hunninghake DB, Treat-Jacobson D, Shumaker S, Zyzanski S, Goldenberg I, Knatterud GL; POST CABG Biobehavioral Study Investigators (2003) Comparison of health-related quality-of-life outcomes of men and women after coronary artery bypass surgery through 1 year: findings from the POST CABG Biobehavioral Study. Am Heart J 146:1038–1044PubMedCrossRefGoogle Scholar
  25. 25.
    Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, Needham DM (2005) Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 31:611–620 DOI 10.1007/s00134-005-2592-6Google Scholar
  26. 26.
    Bell D, Turpin K (1994) Quality of life at three months following admission to intensive and coronary care units. Clin Intensive Care 5:276–281PubMedGoogle Scholar
  27. 27.
    Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299PubMedCrossRefGoogle Scholar
  28. 28.
    Kleinpell RM (2003) Exploring outcomes after critical illness in the elderly. Outcomes Manag 7:159–169PubMedGoogle Scholar
  29. 29.
    Graf J, Koch M, Dujardin R, Kersten A, Janssens U (2003) Health-related quality of life before, 1 month after, and 9 months after intensive care in medical cardiovascular and pulmonary patients. Crit Care Med 31:2163–2169PubMedCrossRefGoogle Scholar
  30. 30.
    Cuthbertson BH, Scott J, Strachan M, Kilonzo M, Vale L (2005) Quality of life before and after intensive care. Anaesthesia 60:332–339PubMedCrossRefGoogle Scholar
  31. 31.
    Dowdy DW, Needham DM, Mendez-Tellez PA, Herridge MS, Pronovost PJ (2005) Studying outcomes of intensive care unit survivors: the role of the cohort study. Intensive Care Med 31:914–921 DOI 10.1007/s00134-005-2657-6Google Scholar
  32. 32.
    Crosby RD, Kolotkin RL, Williams GR (2003) Defining clinically meaningful change in health-related quality of life. J Clin Epidemiol 56:395–407PubMedCrossRefGoogle Scholar
  33. 33.
    Guadagnoli E, Cleary PD (1995) How consistent is patient-reported pre-admission health status when collected during and after hospital stay? Med Care 33:106–112PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Maurizia Capuzzo
    • 1
    Email author
  • Rui P. Moreno
    • 2
  • Barbara Jordan
    • 3
  • Peter Bauer
    • 3
  • Raffaele Alvisi
    • 1
  • Philipp G. H. Metnitz
    • 4
  1. 1.Department of Surgical, Anaesthetic and Radiological Sciences, Service of Anaesthesiology & Intensive CareUniversity Hospital of FerraraFerraraItaly
  2. 2.Unidade de Cuidados Intensivos PolivalenteHospital de St. António dos CapuchosLisbonPortugal
  3. 3.Department of Medical StatisticsMedical University of ViennaViennaAustria
  4. 4.Department of Anaesthesiology and General Intensive CareMedical University of ViennaViennaAustria

Personalised recommendations