Premorbid functional status as a predictor of 1-year mortality and functional status in intensive care patients aged 80 years or older

Pietiläinen, Laura; Hästbacka, Johanna; Bäcklund, Minna; Parviainen, Ilkka; Pettilä, Ville; Reinikainen, Matti

doi:10.1007/s00134-018-5273-y

Cited by 45 publications

(46 citation statements)

References 38 publications

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“…Like other studies detailing the prediction of physical long-term health post ICU admission, we have shown that among our predictors the pre-ICU QoL is by far the most important predictor for long-term QoL (used as the sole predictor a-R 2 = 51.1%) (37)(38)(39). Conversations about pre-ICU health status are already an important part of many ICU physician's manner of providing care.…”

Section: Discussionsupporting

confidence: 59%

Development of PREPARE (PREdicting PAtients’ Long-Term Outcome for REcovery): A Practically Usable Prediction Model for Quality of Life of ICU Survivors

Wubben¹,

Boogaard²,

Ramjith³

et al. 2020

Preprint

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BACKGROUND Though numbers of Intensive Care Unit (ICU) survivors have been increasing, using data on patient-reported long-term physical and mental functioning post-ICU during ICU admission is rare. Individualised information about long-term quality of life (QoL) supports ICU physicians’ decision making and empowers patients to better manage their disease during ICU admission and recovery and rehabilitation. We aimed to develop a prediction model for ICU survivors’ change in QoL one year after ICU admission. METHODS This is a sub-study of an ongoing multicenter prospective cohort study (MONITOR-IC study), in which long-term outcomes of ICU patients are measured up to five years after ICU admission. Adult patients admitted ≥12hrs to the ICU between July 2016 and January 2019 were included. Moribund patients were excluded. Multivariable linear regression and best subsets regression analysis (SRA) were used for building the prediction model. Change in QoL after one year was quantified using the EuroQol five-dimensional (EQ-5D-5L) questionnaire (Dutch range: -0.446–1), and Short-Form 36 (SF-36, range: 0-100). Models were internally validated RESULTS Data on 1308 ICU survivors was used to build the PREdicting PAtients’ long-term outcome for Recovery, PREPARE, prediction model. The best model contained 33 predictors, using the EQ-5D. Explained variance (R2) was 58.0%. Using SRA, we reduced the number of predictors to 5 (R2=55.3%): QoL before admission; sex; Clinical Frailty Scale; a cerebral embolism, occlusion, bleeding or infarction prevalent at or within one hour of admission; and having been admitted to the ICU from the operating room, from the same hospital’s nursing ward. The prediction model using the EQ-5D to quantify QoL had better predictive performance than the best SF-36 model (R2=40.6%).CONCLUSIONS We developed PREPARE, a prediction model for ICU survivors’ QoL one year after ICU admission that is practically usable due to the small number of predictors, measurable within the first 24 hours of admission. The next step is to test and evaluate the use of this prediction model in conversations between ICU physicians and patients and their families to ultimately improve patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov: NCT03246334 on August 11, 2017.

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Section: Discussionsupporting

confidence: 59%

Development of PREPARE (PREdicting PAtients’ Long-Term Outcome for REcovery): A Practically Usable Prediction Model for Quality of Life of ICU Survivors

Wubben¹,

Boogaard²,

Ramjith³

et al. 2020

Preprint

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“…As expected, the proportion of patients with at least moderate impairment of performance status in our study (60%) was much higher than that reported in studies of general critically ill patients [17]. However, the rates of performance status impairment found in our study are even higher than that found in some cohorts of elderly critically ill patients [22], suggesting that cancer burden may impact negatively on performance status of very old patients.…”

Section: Plos Onecontrasting

confidence: 56%

Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country

et al. 2020

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Background Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). Methods This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. Results Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe

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“…Additionally, because the ideal outcome for our patients is to return to their preexisting state or a state expected for a person of the same age and medical condition ( 4 ), insight in the pre-ICU health status may guide the treatment decision-making ( 14 , 18 ). Previous studies that did assess the pre-ICU health status focused often on one specific patient group, such as patients of 80 years old or older ( 26 ), or on one specific pre-ICU health domain, for example, cognitive functioning ( 13 , 27 ), frailty ( 21 ), or quality of life ( 28 , 29 ).…”

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confidence: 99%

Physical, Mental, and Cognitive Health Status of ICU Survivors Before ICU Admission: A Cohort Study

Geense¹,

Boogaard²,

Peters

et al. 2020

Critical Care Medicine

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Premorbid functional status as a predictor of 1-year mortality and functional status in intensive care patients aged 80 years or older

Abstract: Of very old ICU patients, 62% were alive 1 year after ICU admission and 78% of the survivors had a functional status comparable to the premorbid situation. A poor PFS doubled the odds of death within a year. Knowledge of PFS improved the prediction of 1-year mortality.

Cited by 45 publications

References 38 publications

Development of PREPARE (PREdicting PAtients’ Long-Term Outcome for REcovery): A Practically Usable Prediction Model for Quality of Life of ICU Survivors

Development of PREPARE (PREdicting PAtients’ Long-Term Outcome for REcovery): A Practically Usable Prediction Model for Quality of Life of ICU Survivors

Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country

Physical, Mental, and Cognitive Health Status of ICU Survivors Before ICU Admission: A Cohort Study

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