Post-intensive care syndrome as a predictor of mortality in patients with critical illness: A cohort study

Abstract

Introduction The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness. Materials and methods In this retrospective cohort study, we identified 248 critically ill patients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality. Results Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patients died. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 – 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623). Conclusion While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.

Assessment of Sarcopenia in the Intensive Care Unit and 1-Year Mortality in Survivors of Critical Illness

“…A recent study of 248 adult patients with critical illnesses showed that physical disability, defined by low gait speed, was associated with mortality among post-intensive care syndrome components [ 28 ]. ICU-AW and patients with low skeletal muscle mass frequently develop physical disability after ICU discharge [ 2 , 29 , 30 ].…”

Post–Intensive Care Syndrome in Covid-19 Patients Discharged From the Intensive Care Unit

“…Previous studies have shown that hospitalization in the ICU can lead to new physical, cognitive, and psychological disorders that persist even after discharge from the hospital and are known as post–intensive care syndrome (PICS). This suggests that survivors of critical illness are likely to experience PICS, 13 which has been described as a “hidden public health disaster.” 14 The PICS has an adverse effect on clinical and functional outcomes, 15 so it can reduce the survival rate after discharge from the ICU 16 . It is often associated with an inability to return to work, a negative impact on family income, a decrease in quality of life, and an increased risk of death for the next few years (first 3-6 years) 17,18 …”

“…14 The PICS has an adverse effect on clinical and functional outcomes, 15 so it can reduce the survival rate after discharge from the ICU. 16 It is often associated with an inability to return to work, a negative impact on family income, a decrease in quality of life, and an increased risk of death for the next few years (first 3-6 years). 17,18 Patients with Covid-19 are often treated with mechanical ventilation, neuromuscular blocking, and sedation therapy 19 in the ICU, and there is a risk of anxiety and depression, posttraumatic stress disorder, and neurological deficits.…”

Factors influencing long-term recovery in critically ill COVID-19 survivors: A prospective multicentre cohort study

“…At 3 and 12 months, 93/264 (35%) and 138/217 (64%) of patients had a good functional outcome (GOSE ≥7), respectively (Figure 2). The median GOSE was 6 [5][6][7] at 3 months, significantly increasing to 7 [6][7] at 12 months (p<0.001). Meanwhile, GOSE 3-4, indicating dependency in daily life, was found in 20% at 3 months, with a significant decrease to 7% at 12 months (p<0.001) (Table 2).…”