Long-Term Outcomes of Persistent Critical Illness.

Abstract

Rationale: Persistent critical illness (PerCI) describes a growing group of intensive care unit (ICU) patients whose critical illness persist into chronicity. They account for a disproportionate amount of resources, yet long-term functional outcomes are unknown.

Objectives: To compare death or new disability at six months in ICU patients with and without PerCI (defined as ≥10 days ICU stay).

Methods: Secondary analysis of a multi-centre, prospective cohort study conducted in six metropolitan ICUs. Participants were adults admitted to ICU who received >24 hours mechanical ventilation. Patients who died before day 10 were excluded from the control group. The primary outcome was death or new disability at six months, adjusted for various covariates, with new disability defined as ≥10% increase in WHODAS 2.0. Various secondary outcomes (including quality of life, cognition, mental health, return to work) were included to assess recovery holistically at three and six months. A significance level of 0.01 was used to compensate for multiplicity.

Results: Of 888 total enrolled patients, 799 survived to day 10. Of these, the primary outcome was available in 670 (84%) patients, 188 with PerCI and 482 in the control. The primary outcome was present in 124/171 (72.5%) of patients with PerCI and 236/457 (53.9%) of the control124/171 (72.5%) and 236/457 (53.9%) respectively (adjusted risk difference 10.70 [95% CI 0.47-20.90]; p=0.040).]). At six months, the mortality rate was higher in the PerCI group compared to control: respectively 76/252 (30.2%) and 57/547 (10.4%) (adjusted risk difference 15.04 [95% CI 9.65-20.39]; p<0.001).]). In survivors, 48/95 (50.5%) of the PerCI group developed a new disability, compared to 100/311 (32.2%) in the control (adjusted risk difference 9.98 [95% CI -0.27-20.20]; p=0.056).]). Assessment of secondary outcomes showed several differences at three months which were reduced by six months, and residual differences were largely related to physical function.

Conclusion: Patients with PerCI had a higher similar incidence of death or new disability at six months. However, assessment of secondary outcomes showed significant recovery in PerCI survivors between three and six months.