Quality of life before, during and following intensive care treatment: a long term follow-up study

Introduction

Patients recovering from critical illness may show persisting organ dysfunction that could impair functional status (physical, social, emotional function) with an associated reduced health-related quality of life (HRQOL). The purpose of this study was to describe the impact of critical illness and intensive care (ICU) treatment on HRQOL of ICU survivors and to compare their HRQOL with ICU nonsurvivors and an age-matched normal Dutch population.

Patients and methods

A long-term prospective study in ICU patients admitted to the ICU for >48 hours. Patients or proxies completed the Short Form 36 (SF-36) in the first 48 hours of admission, to assess HRQOL in the pre-ICU period. Patients completed the SF-36 at ICU discharge, hospital discharge, and 3 and 6 months after ICU discharge.

Results

Of the 451 included intensive care patients, 252 could be evaluated 6 months after ICU discharge (40 were lost to follow-up, 159 died). A multidimensional drop in SF-36 scores (all P < 0.001) was observed during the ICU stay, with a gradual improvement near to normal functioning at 6 months after ICU discharge. Nevertheless, at 6 months after ICU discharge, physical functioning, general health and social functioning were still decreased (P < 0.05) as compared with baseline values, while all dimensions scores except bodily pain remained lower than in a comparative normal population (all P < 0.05). Pre-admission SF-36 scores of ICU survivors were higher compared with ICU nonsurvivors for seven of the eight dimensions (all P < 0.001; except role-emotional P < 0.05). Moreover, pre-admission HRQOL in ICU patients was already lower than in a normal population.

Conclusion

This study demonstrates that critical illness has a strong impact on HRQOL. A sharp multidimensional decline is followed by gradual recovery towards normal functioning. HRQOL recovery was, however, incomplete in physical functioning, general health and social functioning, and in comparison with the normal population.