Quality of life 6 and 12 months after discharge from the intensive care unit

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Introduction

Mortality alone is a commonly used but non-discriminating outcome measure after critical illness. Although we now view physical, psychological and social outcomes as important [1,2], which assessment tools to apply and when to apply them remains unresolved.

Method

Over a period of one year, we prospectively studied all patients who spent more than 72 h in a tertiary referral intensive care unit (ICU). All eligible patients were then visited by an ICU nurse at their normal residence 6 and 12 months after ICU discharge. They were scored using several scales: functional limitations profile (FLP), acceptance of illness (AOI), generalised self efficacy (GSES), health value (HVS), satisfaction with life (SWLS) and hospital anxiety (HAS) and depression (HDS).

Results

During the study period, there were 557 ICU admissions. ICU and hospital mortality rates were 21% (n=119) and 32% (n=185). Study entry criteria were satisfied by 227 patients of whom 58 were excluded (<18 years old, no longer resident in region, refused to participate, died before interview). FLP scores (mean ± SEM) for the 169 patients (M:F 99:70) at 6 and 12 months were 23.5± 1.20 and 18.2± 1.03 respectively, showing a significant increase in QOL (P<0.001). AOI, HAS and GSES scores also improved between 6 and 12 months while HVS, SWLS and HDS were unchanged. The most significant factors determining QOL at both 6 and 12 months after discharge from ICU were levels of perceived physical and psychosocial limitation as measured by FLP. Age, admission APACHE II score and length of ICU stay did not influence QOL outcomes.

Conclusion

Measures of QOL outcomes in post-ICU patients vary with the assessment tool applied. Several show a significant increase in QOL between 6 and 12 months after ICU discharge and suggest that longer periods of follow-up than previously suggested [3] should be used.