Risk Factors for Functional Decline and Relationship With Quality of Life

Abstract

Background: Certain aspects of intensive care unit admission and care, including patient acuity and treatments to manage acute critical illnesses, can intensify loss of functionality and decrease quality of life after hospital discharge. We sought to identify the risk factors associated with functional decline following critical illness and explore its impact on health-related quality of life in a post hoc analysis of a prospective multi-center cohort study. Methods: The study involved 1,301 critically ill subjects who were assessed 3 months after their discharge from the ICU. The subjects were selected from 10 representative hospitals located across the 5 regions of Brazil, and the assessment period ranged from May 2014 to December 2018. Results: Subjects who were previously able to independently manage their activities of daily living (Barthel score of ≥76) were assessed during their ICU stay and 3 months following ICU discharge. Out of the 954 subjects considered in the analysis, 562 (58.9%) experienced functional decline. The study identified several risk factors associated with functional decline (P < .05), including age ≥65 years (relative risk, 1.179; 95% CI 1.06-1.31), lower educational level (relative risk, 1.14; 95% CI 1.00-1.31), high risk of death in the ICU (relative risk, 1.003; 95% CI 1.001-1.005), and the development of symptoms such as anxiety, depression, or ICU-acquired weakness during ICU stay. Functional decline was also associated with lower scores in both the physical domain (34.7 vs 44.0, P < .001) and the mental domain (48.3 vs 54.1, P < .001) of the Short-Form Health Survey score that measured health-related quality of life. Conclusions: Functional decline is a common outcome following ICU stay, and it is associated with characteristics presented before ICU admission and with the severity of the critical illness. Furthermore, functional decline impacts the quality of life of ICU survivors.

Keywords: critical care; critical care outcomes; functional status; quality of life; rehabilitation.