Health-related quality of life as a prognostic factor of survival in critically ill patients

Abstract

Objective: To evaluate whether health-related quality of life prior to admission into an intensive care unit (ICU) is a prognostic factor of hospital and 1 year mortality.

Design: Prospective cohort study.

Setting: Fourteen-bed medical-surgical ICU.

Patients: A total of 377 patients admitted to the ICU for more than 24 h with 1-year follow-up after discharge from the hospital.

Intervention: A health-related quality of life (HRQoL) survey was conducted, using the questionnaire developed by the "Project for the Epidemiological Analysis of Critical Care Patients", to assess patient's quality of life 1 month before ICU hospitalization.

Results: Hospital mortality was independently associated with severity assessed by APACHE II, odds ratio (OR) 1.14 [95% confidence interval (CI) 1.08-1.2; P < 0.001], high workload assessed by Nine Equivalents of Nursing Manpower Score > 30 OR 3.6 (95% CI 1.4-9.0; P = 0.006), hospital length of stay prior to ICU admission of more than 2 days OR 2.6 (95% CI 1.3-5.4; P = 0.008), and bad quality of life prior to ICU admission assessed by a HRQoL score > or = 8 points OR 2.2 (95% CI 1.03-4.5; P = 0.04). Patients who scored > or =8 on the HRQoL survey presented a risk of demise 12 months after discharge almost twofold that of those who had good previous HRQoL (0-2 points), Hazard Ratio 1.9 (95% CI 1.3-2.8; P = 0.001).

Conclusion: Bad quality of life is associated with hospital mortality and survival 12 months after hospital discharge.