Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study

Abstract

Background Many studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2, but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients’ subjective significance of impairment. Methods A prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for > 48 h were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥ 10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥ 10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients’ subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID). Results Among 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥ 1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6% and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% CI 1.1–18.8, P = 0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively. Conclusions Among the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required. Trial registration UMIN000034072.

Prevalence of and risk factors for post-intensive care syndrome: Multicenter study of patients living at home after treatment in 12 Japanese intensive care units, SMAP-HoPe study

“…They examined 3,151 patients who stayed in the ICU for more than 24 hours and revealed an 18% PTSD prevalence, which was significantly higher than our rate. However, their median APACHE score was 15 (11)(12)(13)(14)(15)(16)(17)(18)(19), which was comparable to that in our study population. A recent systematic review also suggested that illness severity was not associated with the development of PTSD [19]; thus, it is unlikely that mental illness severity at admission contributed to the difference in the prevalence of PTSD between our study and previous studies.…”

“…Although this prevalence was consistent with that reported in a previous systematic review [ 7 ], the population did not reflect the general ICU population in Japan. Kawakami and colleagues [ 11 ] reported the effects on physical and mental QOL, as measured by the Short Form 36, and cognitive impairment after 6 months among 96 patients who required mechanical ventilation (MV) for more than 48 hours in 16 ICUs in Japan. However, they did not clarify the prevalence of PTSD, anxiety, or depression.…”

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

“…Prolonged physical impairments occur in approximately 30% of ICU survivors 3-6 months after critical illness [5,6]. The 6-min walk test outcomes deteriorate below the normal level at the mean distances of 361 m at 3 months and at 411 m at 60 months after discharge [9].…”

“…PICS is the collective manifestation of a prolonged physical impairment, cognitive impairment, and mental health problems that occur during or after intensive care unit (ICU) stay and affects not only the long-term outcomes of ICU patients but also the mental health of the patients' families [4]. Individual PICS symptoms have been reported to develop in 50-70% of critically ill patients, and their co-occurrence has been approximately evidenced in 20% of patients [5,6]. It is known that the QOL of patients decreases with the onset of PICS, and approximately two-thirds, two-fifths, and one-third of previously employed ICU survivors are jobless up to 3, 12, and 60 months following hospital discharge [3].…”

Roles of Early Mobilization Program in Preventing Muscle Weakness and Decreasing Psychiatric Disorders in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Cohort Study

“…A case series analysis in COVID-19 patients [9] reported a higher rate (75%) of delirium but a lower incidence of cognitive impairment and a higher 6 min walk distance at the 6 week follow-up than in non-COVID ARDS patients, quite similar to our findings. Previously, it was reported that the prevalence of PICS among ICU patients in Japan was 63.5%, and 32%, 15%, and 38% had physical, mental, and cognitive impairment, respectively, [10] indicating that the prevalence of psychological disorders was higher in that study. Dinglas and colleagues reported that 38% of patients with non-COVID-19 ARDS had significant muscle weakness at hospital discharge, sustained muscle weakness was found in 50%, and muscle weakness had an impact on the 5-year survival rate.…”