Intensive care (ICU) survivors frequently report reduced health-related quality of life (HRQoL), but the relative importance of pre-illness versus acute illness factors in survivor populations is not well understood. We aimed to explore HRQoL trajectories over 12 months following ICU discharge, patterns of improvement or deterioration over this period, and the relative importance of demographics (age, gender, social deprivation), pre-existing health (functional comorbidity index (FCI)), and acute illness severity (APACHE II score, ventilation days) as determinants of HRQoL and relevant patient-reported symptoms during the year following ICU discharge.
Nested cohort study within a previously published randomised controlled trial.
Two ICUs in Edinburgh, Scotland.
Adult ICU survivors (N=240) who required more than 48 hours mechanical ventilation (MV).
Measurements and Main Results
We prospectively collected data for age, gender, social deprivation (Scottish Index of Multiple Deprivation), pre-existing comorbidity (Functional Comorbidity Index), APACHE II score, and days of mechanical ventilation (MV). HRQoL (Medical Outcomes Study Short Form version 2 (SF12 v2) physical (PCS) and mental (MCS) components scores) and patient-reported symptoms (appetite, fatigue, pain, joint stiffness and breathlessness) were measured at 3, 6, and 12 months. Mean PCS and MCS were reduced at all time points with minimal change between 3 and 12 months. In multivariable analysis increasing pre-ICU comorbidity count was strongly associated with lower HRQoL (PCS =-1.56 (-2.44 to -0.68); p=0.001; MCS = -1.45 (-2.37 to -0.53); p=0.002) and more severe self-reported symptoms. In contrast, APACHE II score and MV days were not associated with HRQoL. Older age ( 0.33 (0.19 to 0.47); p <0.001) and lower social deprivation ( 1.38 (0.03 to 2.74); p=0.045) were associated with better MCS HRQoL.
Pre-existing comorbidity count, but not severity of ICU illness, are strongly associated with HRQoL and physical symptoms in the year following critical illness.