Long-term outcome of prolonged critical illness: A multicentered study in North Brisbane, Australia

Abstract

Background Although critical illness is usually of high acuity and short duration, some patients require prolonged management in intensive care units (ICU) and suffer long-term morbidity and mortality. Objective To describe the long-term survival and examine determinants of death among patients with prolonged ICU admission. Methods A retrospective cohort of adult Queensland residents admitted to ICUs for 14 days or longer in North Brisbane, Australia was assembled. Comorbid illnesses were classified using the Charlson definitions and all cause case fatality established using statewide vital statistics. Results During the study a total of 28,742 adult Queensland residents had first admissions to participating ICUs of which 1,157 (4.0%) had prolonged admissions for two weeks or longer. Patients with prolonged admissions included 645 (55.8%), 243 (21.0%), and 269 (23.3%) with ICU lengths of stay lasting 14–20, 21–27, and ≥28 days, respectively. Although the severity of illness at admission did not vary, pre-existing comorbid illnesses including myocardial infarction, congestive heart failure, kidney disease, and peptic ulcer disease were more frequent whereas cancer, cerebrovascular accidents, and plegia were less frequently observed among patients with increasing ICU lengths of stay lasting 14–20, 21–27, and ≥28 days. The ICU, hospital, 90-day, and one-year all cause case-fatality rates were 12.7%, 18.5%, 20.2%, and 24.9%, respectively, and were not different according to duration of ICU stay. The median duration of observation was 1,037 (interquartile range, 214–1888) days. Although comorbidity, age, and admitting diagnosis were significant, neither ICU duration of stay nor severity of illness at admission were associated with overall survival outcome in a multivariable Cox regression model. Conclusions Most patients with prolonged stays in our ICUs are alive at one year post-admission. Older age and previous comorbidities, but not severity of illness or duration of ICU stay, are associated with adverse long-term mortality outcome.

Impact of frailty on persistent critical illness: a population-based cohort study

“…Thus, it is unclear whether frailty affects longer term outcomes after PerCI. It is noteworthy, however, that prior studies have demonstrated particularly poor long-term survival after PerCI (25–50% of initial survivors dead at 1-year), with mortality increasing with age [ 20 , 21 ]. As the prevalence of frailty is considerably greater in older critically ill patients, it is also likely to be an important factor contributing to the disproportionately poor long-term outcomes for older survivors of PerCI.…”

Experiences of families of prolonged critical illness survivors that are discharged home: An integrative review of the literature

“…Articles also had to be of relevance to a prolonged ICU stay, which for this search, included any article listed as an ICU admission for five days or more as this is still considered prolonged when one considers the median LOS being two days (IQR 2-4). 40 We initially sought to include studies with an ICU LOS greater than or equal to seven days to align with the definition of a long-term ICU patient suggested by Alexandersen et al, 41 Dammann et al, 30 and Haugdahl et al 42 but this yielded too few studies for the review. It has been acknowledged in the literature the many definitions used to define a long stay in ICU and the complexity this creates when reviewing the best evidence.…”

A protocol for exploring patients' and support peoples' experiences after prolonged critical illness

“…1 Up to 51% of patients with prolonged critical illness may be readmitted to hospital in the first year following discharge 10 and one-year mortality rates are 24.9%. 50 We are, therefore, aware there may be a need to recruit new participants into the study and accept that there may be attrition in the cohort.…”

“…Also, the high morbidity and mortality rate of the study population presents a further limitation. Recent data suggest that in Australia and New Zealand between 18.5% and 24.5% of patients with prolonged critical illness die in hospital 1,50 and only 46.5% are discharged home 1 . Up to 51% of patients with prolonged critical illness may be readmitted to hospital in the first year following discharge 10 and one‐year mortality rates are 24.9% 50 .…”