Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study

doi:10.1186/s13054-021-03501-z

Observational Study

. 2021 Feb 16;25(1):69.

doi: 10.1186/s13054-021-03501-z.

Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study

Daisuke Kawakami¹, Shigeki Fujitani², Takeshi Morimoto³, Hisashi Dote⁴, Mumon Takita², Akihiro Takaba⁵, Masaaki Hino⁶, Michitaka Nakamura⁷, Hiromasa Irie⁸, Tomohiro Adachi⁹, Mami Shibata¹⁰, Jun Kataoka¹¹, Akira Korenaga¹², Tomoya Yamashita¹³, Tomoya Okazaki¹⁴, Masatoshi Okumura¹⁵, Takefumi Tsunemitsu¹⁶

Affiliations

¹ Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, 2-1-1, Minatojima minamimachi, Chuo-ku, Kobe-City, Hyogo Prefecture, 650-0047, Japan. dsk_kwkm_n9s@hotmail.co.jp.
² Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa Prefecture, 216-8511, Japan.
³ Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo Prefecture, 663-8501, Japan.
⁴ Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka Prefecture, 430-8558, Japan.
⁵ Department of Emergency and Critical Care Medicine, Hiroshima General Hospital, Hatsukaichi, JAHisoshima Prefecture, 738-8503, Japan.
⁶ Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama Prefecture, 710-8602, Japan.
⁷ Department of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Nara Prefecture, 630-8581, Japan.
⁸ Department of Anesthesiology, Kurashiki Central Hospital, Kurashiki, Okayama Prefecture, 710-8602, Japan.
⁹ Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East, Tokyo, 116-8567, Japan.
¹⁰ Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Wakayama Prefecture, 641-8510, Japan.
¹¹ Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, 279-0001, Japan.
¹² Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Wakayama Prefecture, 640-8558, Japan.
¹³ Department of Emergency and Critical Care, Osaka City General Hospital, Osaka, 534-0021, Japan.
¹⁴ Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa Prefecture, 761-0793, Japan.
¹⁵ Department of Anesthesiology, Aichi Medical University Hospital, Nagakute, Aichi Prefecture, 480-1195, Japan.
¹⁶ Department of Emergency Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo Prefecture, Amagasaki, 660-8550, Japan.

PMID: 33593406
PMCID: PMC7888178
DOI: 10.1186/s13054-021-03501-z

Observational Study

Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study

Daisuke Kawakami et al. Crit Care. 2021.

. 2021 Feb 16;25(1):69.

doi: 10.1186/s13054-021-03501-z.

Authors

Affiliations

¹ Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, 2-1-1, Minatojima minamimachi, Chuo-ku, Kobe-City, Hyogo Prefecture, 650-0047, Japan. dsk_kwkm_n9s@hotmail.co.jp.
² Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa Prefecture, 216-8511, Japan.
³ Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo Prefecture, 663-8501, Japan.
⁴ Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka Prefecture, 430-8558, Japan.
⁵ Department of Emergency and Critical Care Medicine, Hiroshima General Hospital, Hatsukaichi, JAHisoshima Prefecture, 738-8503, Japan.
⁶ Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama Prefecture, 710-8602, Japan.
⁷ Department of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Nara Prefecture, 630-8581, Japan.
⁸ Department of Anesthesiology, Kurashiki Central Hospital, Kurashiki, Okayama Prefecture, 710-8602, Japan.
⁹ Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East, Tokyo, 116-8567, Japan.
¹⁰ Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Wakayama Prefecture, 641-8510, Japan.
¹¹ Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, 279-0001, Japan.
¹² Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Wakayama Prefecture, 640-8558, Japan.
¹³ Department of Emergency and Critical Care, Osaka City General Hospital, Osaka, 534-0021, Japan.
¹⁴ Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa Prefecture, 761-0793, Japan.
¹⁵ Department of Anesthesiology, Aichi Medical University Hospital, Nagakute, Aichi Prefecture, 480-1195, Japan.
¹⁶ Department of Emergency Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo Prefecture, Amagasaki, 660-8550, Japan.

PMID: 33593406
PMCID: PMC7888178
DOI: 10.1186/s13054-021-03501-z

Abstract

Background: Many studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2, but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients' subjective significance of impairment.

Methods: A prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for > 48 h were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥ 10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥ 10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients' subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID).

Results: Among 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥ 1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6% and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% CI 1.1-18.8, P = 0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively.

Conclusions: Among the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required. Trial registration UMIN000034072.

Keywords: Critical care; Disability; Health-related quality of life; Intensive care unit; Mechanical ventilation; Post-intensive care syndrome; SF-36.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Flowchart depicting the enrollment of subjects in the study. *ICU* Intensive care unit, *SF-36* 36-item short-form health survey questionnaire, *SMQ* Short-Memory Questionnaire, *PICS* post-intensive care syndrome

**Fig. 2**
Changes in SF-36 PCS, MCS and SMQ scores before and after ICU admission. *SF-36* 36-item short-form health survey questionnaire, *PCS* physical component scale, *MCS* mental component scale, *SMQ* Short-Memory Questionnaire, *ICU* intensive care unit

**Fig. 3**
Occurrence of PICS problems among patients at 6 months after ICU admission. *PICS* post-intensive care syndrome

See this image and copyright information in PMC

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References

1. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012;40:502–509. - PubMed
1. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–1304. - PubMed
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1. Righy C, Rosa RG, da Silva RTA, Kochhann R, Migliavaca CB, Robinson CC, et al. Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis. Crit Care. 2019;23:213. - PMC - PubMed

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[1] Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012;40:502–509. - PubMed

[2] Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012;40:502–509. - PubMed

[3] Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–1304. - PubMed

[4] Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–1304. - PubMed

[5] Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306–1316. - PMC - PubMed

[6] Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369:1306–1316. - PMC - PubMed

[7] Sivanathan L, Wunsch H, Vigod S, Hill A, Pinto R, Scales DC. Mental illness after admission to an intensive care unit. Intensive Care Med. 2019;45:1550–1558. - PubMed

[8] Sivanathan L, Wunsch H, Vigod S, Hill A, Pinto R, Scales DC. Mental illness after admission to an intensive care unit. Intensive Care Med. 2019;45:1550–1558. - PubMed

[9] Righy C, Rosa RG, da Silva RTA, Kochhann R, Migliavaca CB, Robinson CC, et al. Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis. Crit Care. 2019;23:213. - PMC - PubMed

[10] Righy C, Rosa RG, da Silva RTA, Kochhann R, Migliavaca CB, Robinson CC, et al. Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis. Crit Care. 2019;23:213. - PMC - PubMed

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Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study

Affiliations

Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study

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Abstract

Conflict of interest statement

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