Long-term health-related quality of life and mortality in chronic critically ill patients

Abstract

The increasing prevalence of chronic critically ill patients makes it essential to understand the impacts of this condition, through studies that include multidimensional assessments. The aim of this study is to assess long-term mortality and health-related quality of life in chronic critically ill patients. Prospective cohort study with chronic critically ill patients after intensive care unit discharge. The baseline health status was assessed using the following scales: EuroQol 5 Dimensions 3 Levels, 36-Item Short Form, Rankin Scale, Barthel Index, and Hospital Anxiety and Depression Score. The same questionnaires plus the Impact of Event Scale were applied in the 3- and 6-month follow-up. After 3 years, vital status was checked and the EQ-5D-3L was applied. In total, 130 patients were included, with a median age of 60.5 years (IQR 42–70). All participants included in the study completed the questionnaires at baseline. Responses were obtained from 44 participants at 3 months, 29 participants at 6 months, and 66 participants at 3 years. Overall, 26 participants contributed to the 3 years complete-case longitudinal EuroQol 5 Dimensions 3 Levels analysis. Compared with retrospectively recalled pre-hospital baseline, physical and functional health measures were numerically worse at 3 months after intensive care unit discharge and showed partial improvement at 6 months and 3 years. Furthermore, on the 36-Item Short Form, overall differences across timepoints were observed in the domains of functional capacity ( p = 0.003) and social aspects ( p = 0.01). In the forward stepwise multivariable Cox model, the variables independently associated with death were age (adjusted HR 1.04 per year; 95% CI 1.02–1.06; p < 0.001), the modified Rankin Scale score (adjusted HR 1.23; 95% CI 1.06–1.43; p = 0.006), and number of comorbidities (adjusted HR 1.26; 95% CI 1.04–1.52; p = 0.01). Among survivors with available follow-up data, physical and functional health measures showed results suggesting lower scores at 3 and 6 months than at the retrospectively recalled pre-hospital baseline. In the subgroup with complete longitudinal health-related quality of life data, the 3-year unadjusted median index value remained below the recalled baseline. Age, number of comorbidities, and the modified Rankin Scale score were associated with death.