Survival, morbidity, and quality of life after discharge from intensive care

Objective: To assess survival, morbidity (physical and psychological), qual ity of life (QOL), and employment status of intensive care survivors up to 12 months after discharge from the intensive care unit (ICU). Design: Prospective study, Setting: University hospital adult ICU, Patients: Between August 1, 1995, and July 31, 1996, 370 patients were admi tted. Of these patients, 29% died in the ICU. Three months after discharge from the ICU, 227 patients were alive, and 143 agreed to participate. Cumul ative mortality was calculated using the original complete cohort. Measurements and Main Results: Demographic data, severity of acute illness (Acute Physiology and Chronic Health Evaluation [APACHE] II), admitting spe cialty, primary diagnosis, and length of stay were recorded. Physical and I CU-related psychological morbidity (Hospital Anxiety and Depression scale s core) were recorded. Health-related QOL was assessed using the Short-Form 3 6. All the questionnaires were completed in the clinic at 3 months. Assessm ent of physical morbidity and employment status at 6 and 12 months were con ducted by telephone. The cumulative mortality was 39% at 3 months, 41% at 6 months, and 43% at 12 months. Deaths after 3 months occurred in the group who refused follow-up. The median age for the follow-up group was 51 yrs; t he gender split was 58 women and 75 men; the mean admission APACHE II score was 18.79 (SD 6.15); and the median length of ICU stay was 3.8 days. At 3 months, similar to 80% of all patients interviewed were satisfied with their QDL. Older men (>65 yrs) and younger women (<65 yrs) demonstrated si gnificantly better health with respect to some subdomains of the Short-Form 36 compared with their counterparts. The prevalence of psychological distr ess (Hospital Anxiety and Depression scale score, greater than or equal to 8) was low: 11.9% had heightened anxiety, and 9.8% were depressed. There we re high levels of fatigue, poor concentration, and sleep disturbance; the l atter was more marked in women (p = .022). Improvement in all three symptom s occurred during the next 9 months. Significantly more women reported loss of hair (p < .0001). Men were slower to return to employment; 75% of women had returned by 6 months compared with only 65% of men at 1 yr. Conclusion: Assessment of outcome after ICU stay must include QOL measureme nts. Three months after discharge, there is a low incidence of ICU-related psychological or psychiatric illness and the majority of patients are satis fied. Differences in the incidence and nature of morbidity exist between th e genders.