Multimorbidity and its relationship with long-term outcomes following critical care discharge: a prospective cohort study

J McPeake, Tara Quasim, P Henderson, AH Leyland, NI Lone, Matthew Walters, TJ Iwashyna, M Shaw

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Survivors of critical illness have poor long-term outcomes with subsequent increases in healthcare utilisation. Less is known about the interplay between multimorbidity and long-term outcomes. Research question: How do baseline patient demographics impact mortality and healthcare utilisation in the year following discharge from critical care? Study design and methods: Using data from a prospectively collected cohort, we employed propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital without critical care. Long-term mortality was examined via nationally linked data as was hospital resource use in the year following hospital discharge. The cause of death was also examined. Results: This analysis included 3112 participants. There was no difference in long-term mortality between the critical care and hospital cohorts (adjusted HR: 1.09 (95% CI: 0.90-1.32), p=0.39). Pre-hospitalisation emotional health issues such as a clinical diagnosis of depression, were associated with increased long-term mortality (HR:1.49 (95% CI: 1.14-1.96), p<0.004). Healthcare utilisation was different between the two cohorts in the year following discharge with the critical care cohort experiencing a 29% increased risk of hospital readmission (OR 1.29 (95% CI:1.11-1.50), p=0.001). Interpretation: This national cohort study has demonstrated increased resource use for critical care survivors in the year following discharge but fails to replicate past findings of increased longer-term mortality. Multimorbidity, lifestyle factors and socio-economic status appear influence long term outcomes and should be the focus of future research.
Original languageEnglish
JournalChest
Early online date18 Jun 2021
DOIs
Publication statusE-pub ahead of print - 18 Jun 2021

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