To evaluate health-related quality of life (HR-QOL) and study its determinants in adult patients discharged from an intensive care unit (ICU).
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.
"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   : 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 "
[Show abstract][Hide abstract] 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
"Furthermore, the test-retest reliability of SF-36 in the intensive care population has been shown to be good [25,26]. We also used the EQ-5D, which has been recommended for evaluating ICU populations [10,15,27], to facilitate comparison with one of the few studies in this area: the UK CAOS study . "
[Show abstract][Hide abstract] ABSTRACT: Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.
Fifty-one COPD patients (COPD-ICU group) with an ICU stay longer than 24 hours received a questionnaire at 6, 12 and 24 months after discharge from ICU. HRQL was measured using two generic instruments: the EuroQoL instrument (EQ-5D and EQ-VAS) and the Short Form 36 Health Survey (SF-36). The results were compared to HRQL of two reference groups from the general population; an age- and sex-adjusted reference population (Non-COPD reference) and a reference group with COPD (COPD reference).
HRQL of the COPD-ICU group at 6 months after discharge from ICU was lower compared to the COPD reference group: Median EQ-5D was 0.66 vs. 0.73, P=0.08 and median EQ-VAS was 50 vs.55, P<0.05. There were no significant differences in the SF-36 dimensions between the COPD-ICU and COPD-reference groups, although the difference in physical functioning (PF) approached statistical significance (P=0.059). Patients in the COPD-ICU group who were lost to follow-up after 6 months had low HRQL scores at 6 months. Scores for patients who died were generally lower compared to patients who failed to respond to the questionnaire. The PF and social functioning (SF) scores in those who died were significantly lower compared to patients with a complete follow up. HRQL of patients in the COPD-ICU group that survived a complete 24 months follow up was low but stable with no statistically significant decline from 6 to 24 months after ICU discharge. Their HRQL at 24 months was not significantly different from HRQL in the COPD reference group.
HRQL in COPD survivors after intensive care was low but did not decline from 6 to 24 months after discharge from ICU. Furthermore, HRQL at 24 months was similar to patients with COPD who had not received ICU treatment.
"This shows a relatively high level of HR-QOL among an important percentage of those who survived 6 months after discharge from the PACU and these findings agree with those of other reports that used different tools [7,48]. This is important because according to SF-36 scores revealed that there were no differences in quality of life before and after surgery, except in the physical function domain. "
[Show abstract][Hide abstract] ABSTRACT: Background
Most studies that follow up hepatectomy cases are limited in scope to an investigation of mortality and morbidity rates or the costs and length of hospital stay. In this study the authors aimed to characterize the quality of life and to evaluate mortality and its determinants after hepatectomy.
This prospective study was carried in a Post-Anaesthesia Care Unit (PACU) over 15 months, and 70 patients submitted to hepatectomy were enrolled. Demographic and peri-operative characteristics were evaluated for associations with mortality. At admission and 6 months after discharge, patients completed a Short Form-36 questionnaire (SF-36) and have their independence in Activities of Daily Living (ADL) was evaluated. Binary and multiple logistic regression analyses were used to evaluate of associations with mortality, and the Wilcoxon signed rank test was used to compare SF-36 scores before and after 6 months after hepatectomy.
The mortality rate was 19% at 6 months. Multivariate analysis identified postoperative delirium as an independent determinant for mortality. Six months after discharge, 46% patients stated that their health in general was better or much better than that 1 year previously. Six months after hepatectomy, patients had worse scores in the physical function domain of SF-36; however, scores for all the other domains did not differ. At this time point, patients were more dependent in instrumental ADL than before surgery (32% versus 7%, p = 0.027).
This study identified postoperative delirium as an independent risk factor for mortality 6 months after hepatectomy. After 6 months, survivors were more dependent in instrumental ADL tasks and had worse scores in the physical function domain of SF-36.
F. Efficace, G. Rosti, M. Breccia, F. Cottone, J. M. Giesinger, F. Stagno, A. Iurlo, A. Russo Rossi, L. Luciano, B. Martino, S. Galimberti, D. Turri, M. Bergamaschi, M. Tiribelli, C. Fava, E. Angelucci, F. Mandelli, M. Baccarani
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