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The Impact of Critical Illness on Perceived Health-Related Quality of Life During ICU Treatment, Hospital Stay, and After Hospital Discharge^*

A Long-term Follow-up Study

^* From Erasmus MC University Medical Center (Ms. Hofhuis and Dr. Bakker), Rotterdam, the Netherlands; the Department of ICU (Drs. Spronk and Rommes), Gelre Hospital, Apeldoorn, the Netherlands; and the Julius Center for Health Sciences and Primary Care (Mr. van Stel and Mr. Schrijvers), University Medical Centre Utrecht, Utrecht, the Netherlands.

Correspondence to: Jan Bakker, MD, PhD, Erasmus MC University Medical Center Rotterdam, Department of ICU, PO Box 2040, Room HS320, 3000 CA Rotterdam, the Netherlands; e-mail: jan.bakker{at}erasmusmc.nl

Abstract

Background: The time course of changes in health-related quality of life (HRQOL) following discharge from the ICU and during a general ward stay has not been studied. We therefore studied the immediate impact of critical illness on HRQOL and its recovery over time.

Methods: In a prospective study, all patients admitted to the ICU for > 48 h who ultimately survived to follow-up at 6 months were included. The Medical Outcomes Study 36-item short form was used to measure HRQOL before ICU admission, at discharge from the ICU and hospital, and at 3 and 6 months following discharge from the ICU and hospital. An age-matched healthy Dutch population was used as a reference.

Results: Of the 451 included patients, 252 could be evaluated at 6 months (40 were lost to follow-up, and 159 died). Pre-ICU admission HRQOL in survivors was significantly worse compared to the healthy population. Patients who died between ICU admission and long-term follow-up had significantly worse HRQOL in all dimensions already at ICU admission when compared to the long-term survivors. HRQOL decreased in all dimensions (p < 0.001) during ICU stay followed by a rapid improvement during hospital stay, gradually improving to near pre-ICU admission HRQOL at 6 months following ICU discharge. Physical functioning (PF), general health (GH), and social functioning (SF) remained significantly lower than pre-ICU admission values. Compared to the healthy Dutch population, ICU survivors had significantly lower HRQOL 6 months following ICU discharge (except for the bodily pain score).

Conclusions: A sharp multidimensional decline in HRQOL occurs during ICU admission where recovery already starts following ICU discharge to the general ward. Recovery is incomplete for PF, GH, and SF when compared to baseline values and the healthy population.

Key Words: critical care • critical illness • health-related quality of life • ICU • long-term survivors • Medical Outcomes Study 36-item short form • proxy • quality of life

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Health-Related Quality of Life: An Outcome Variable in Critical Care Survivors

Élie Azoulay, Nancy Kentish-Barnes, and Frédéric Pochard
Chest 2008 133: 339-341. [Full Text] [PDF]

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				E. Azoulay, N. Kentish-Barnes, and F. Pochard Health-Related Quality of Life: An Outcome Variable in Critical Care Survivors Chest, February 1, 2008; 133(2): 339 - 341. [Full Text] [PDF]