Quality of life after intensive care: evaluation with EQ-5D

Intensive Care Unit, Hospital Pedro Hispano, 4450, Matosinhos, Portugal.
Intensive Care Medicine (Impact Factor: 5.54). 08/2002; 28(7):898-907. DOI: 10.1007/s00134-002-1345-z
Source: PubMed

ABSTRACT To evaluate health-related quality of life (HR-QOL) and study its determinants in adult patients discharged from an intensive care unit (ICU).
Cohort study.
Intensive care unit (ICU), tertiary care hospital, Oporto, Portugal.
Of all the patients discharged over a 2 year period, 355 were considered eligible and 275 completed the study.
Patients were interviewed 6 months after ICU discharge using EuroQol 5-D (EQ-5D). At the interview only 29% reported feeling worse than 6 months before ICU admission. The proportions of those reporting moderate to extreme problems in the five dimensions studied were as follows: mobility (37%), self-care (22%), usual activities (46%), pain/discomfort (45%) and anxiety/depression (54%). Although 77% of patients reported a problem in at least one dimension, 44% referred to no problems or only moderate problems regarding pain or anxiety. EQ visual analogue scale (VAS) and EQ Index medians were 60 and 81, respectively.
Intensive care unit variables (e.g., diagnosis, length of stay and severity of disease) and patient's background data (e.g., age, gender, education, main activity, smoking habits, experience with serious illness and previous health status) may be significant determinants of HR-QOL. However, when adjusted for background data, most ICU variables are no longer associated with EQ-5D. This should cause attention to be paid to the role of a patient's background in the evaluation of HR-QOL and to a careful interpretation of EQ-5D results when comparing ICUs.

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    • "Third, Bayesian networks present competitive performance, comparing with other less descriptive models like logistic regression proposed elsewhere in literature. Fourth, generated models expose relationships among variables which are concordant with previous works [6] [22] [23]: for the 6 weeks prognosis, the youngest and those who had a lower APACHE II have a lower risk of QoL problems; for the 6 months prognosis, with exception for anxiety/depression, the male patients, the younger, those with lower "
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    ABSTRACT: Health-related quality of life (HR-QoL) is a subjective concept, reflecting the overall mental and physical state of the patient, and their own sense of well-being. Estimating current and future QoL has become a major outcome in the evaluation of critically ill patients. The aim of this study is to enhance the inference process of 6 weeks and 6 months prognosis of QoL after intensive care unit (ICU) stay, using the EQ-5D questionnaire. The main outcomes of the study were the EQ-5D five main dimensions: mobility, self-care, usual activities, pain and anxiety depression. For each outcome, three Bayesian classifiers were built and validated with 10-fold cross-validation. Sixty and 473 patients (6 weeks and 6 months, respectively) were included. Overall, 6 months QoL is higher than 6 weeks, with the probability of absence of problems ranging from 31% (6 weeks mobility) to 72% (6 months self-care). Bayesian models achieved prognosis accuracies of 56% (6 months, anxiety depression) up to 80% (6 weeks, mobility). The prognosis inference process for an individual patient was enhanced with the visual analysis of the models, showing that women, elderly, or people with longer ICU stay have higher risk of QoL problems at 6 weeks. Likewise, for the 6 months prognosis, a higher APACHE II severity score also leads to a higher risk of problems, except for anxiety depression where the youngest and active have increased risk. Bayesian networks are competitive with less descriptive strategies, improve the inference process by incorporating domain knowledge and present a more interpretable model. The relationships among different factors extracted by the Bayesian models are in accordance with those collected by previous state-of-the-art literature, hence showing their usability as inference model.
    2014 IEEE 27th International Symposium on Computer-Based Medical Systems (CBMS); 05/2014
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    • "The utility value of the QOL for PMV patients was measured using the EuroQol five-dimensional (EQ-5D) questionnaire. It is a preference-based, generic instrument [20] [21] and has been extensively used in many critically ill patients based on multi-attribute utility theory [22] [23] [24]. The five dimensions assessed by the EQ-5D are mobility, self-care, usual activities, pain/discomfort , and anxiety/depression, each with three levels of severity (no problems, some/moderate problems, and severe/extreme problems). "
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    ABSTRACT: The purpose of this study was to estimate the quality-adjusted life expectancy (QALE) and the expected lifetime utility loss of patients with prolonged mechanical ventilation (PMV). PMV was defined as more than 21 days of mechanical ventilation. A total of 633 patients fulfilled this definition and were followed for 9 years (1998-2007) to obtain their survival status. Quality of life of 142 patients was measured with the EuroQol five-dimensional (EQ-5D) questionnaire during the period 2008 to 2009. The survival probabilities for each time point were adjusted with a utility measurement of quality of life and then extrapolated to 300 months to obtain the QALE. We compared the age-, gender-matched reference populations to calculate the expected lifetime utility loss. The average age of subjects was 76 years old. The life expectancy and loss of life expectancy were 1.95 years and 8.48 years, respectively. The QALE of 55 patients with partial cognitive ability and the ability to respond was 0.58 quality-adjusted life years (QALY), whereas the QALEs of 87 patients with poor consciousness were 0.28 and 0.29 QALY for the EQ-5D measured by family caregivers and nurses, respectively. The loss of QALE for PMV patients was 9.87 to 10.17 QALY, corresponding to a health gap of 94% to 97%. Theses results of poor prognosis would provide stakeholders evidence for communication to facilitate clinical decisions. The estimation may be used in future studies to facilitate the cost-effectiveness and reduction of the health gap.
    Value in Health 03/2011; 14(2):347-53. DOI:10.1016/j.jval.2010.09.006 · 2.89 Impact Factor
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    • "The patients' functioning during the recovery phase can also be regarded as an important indicator of the treatment and quality of care. A study of health-related quality of life six months after discharge from an ICU revealed that 54% of the former patients reported feeling better and 29% feeling worse than six months before ICU admission (Granja et al. 2002). Chaboyer & Grace (2003) found that former patients still had problems one year after discharge. "
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    ABSTRACT: Thesis (doctoral)--Linköping University, 2006.
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