One-year survival and resource use after critical illness: impact of organ failure and residual organ dysfunction in a cohort study in Brazil

• Published in: Critical care (London, England) Vol. 19; no. 1; p. 269
• Main Authors: Ranzani, Otavio T, Zampieri, Fernando G, Besen, Bruno A M P, Azevedo, Luciano C P, Park, Marcelo
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.06.2015; BioMed Central
• Subjects: Adult Day Care Centers - utilization; Age Factors; Ambulatory Care - utilization; Analysis; Blood & organ donations; Brazil; Brazil - epidemiology; Clinics; Cohort analysis; Cohort Studies; Critical care; Critical Illness; Data analysis; Emergency Service, Hospital - utilization; Female; Health aspects; Hospitals; Humans; Illnesses; Intensive care; Intensive Care Units; Lung diseases, Obstructive; Male; Medical prognosis; Medical research; Medicine, Experimental; Middle Aged; Mortality; Multiple organ dysfunction syndrome; Multiple Organ Failure - epidemiology; Multivariate Analysis; Neoplasms - epidemiology; Organ Dysfunction Scores; Patient Discharge; Patient outcomes; Patient Readmission - statistics & numerical data; Psychiatric services; Pulmonary Disease, Chronic Obstructive - epidemiology; Quality of life; Sepsis; Serum Albumin; Services; Survival analysis; Survivors; Ventilators; Brazil
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-015-0986-6

In this study, we evaluated the impacts of organ failure and residual dysfunction on 1-year survival and health care resource use using Intensive Care Unit (ICU) discharge as the starting point. We conducted a historical cohort study, including all adult patients discharged alive after at least 72 h of ICU stay in a tertiary teaching hospital in Brazil. The starting point of follow-up was ICU discharge. Organ failure was defined as a value of 3 or 4 in its corresponding component of the Sequential Organ Failure Assessment score, and residual organ dysfunction was defined as a score of 1 or 2. We fit a multivariate flexible Cox model to predict 1-year survival. We analyzed 690 patients. Mortality at 1 year after discharge was 27%. Using multivariate modeling, age, chronic obstructive pulmonary disease, cancer, organ dysfunctions and albumin at ICU discharge were the main determinants of 1-year survival. Age and organ failure were non-linearly associated with survival, and the impact of organ failure diminished over time. We conducted a subset analysis with 561 patients (81%) discharged without organ failure within the previous 24 h of discharge, and the number of residual organs in dysfunction remained strongly associated with reduced 1-year survival. The use of health care resources among hospital survivors was substantial within 1 year: 40% of the patients were rehospitalized, 52% visited the emergency department, 90% were seen at the outpatient clinic, 14% attended rehabilitation outpatient services, 11% were followed by the psychological or psychiatric service and 7% used the day hospital facility. Use of health care resources up to 30 days after hospital discharge was associated with the number of organs in dysfunction at ICU discharge. Organ failure was an important determinant of 1-year outcome of critically ill survivors. Nevertheless, the impact of organ failure tended to diminish over time. Resource use after critical illness was elevated among ICU survivors, and a targeted action is needed to deliver appropriate care and to reduce the late critical illness burden.