TY - JOUR
T1 - Predictors of death and new disability after critical illness
T2 - a multicentre prospective cohort study
AU - Higgins, A. M.
AU - Neto, A. Serpa
AU - Bailey, M.
AU - Barrett, J.
AU - Bellomo, R.
AU - Cooper, D. J.
AU - Gabbe, B. J.
AU - Linke, N.
AU - Myles, P. S.
AU - Paton, M.
AU - Philpot, S.
AU - Shulman, M.
AU - Young, M.
AU - Hodgson, C. L.
AU - on behalf of the PREDICT Study Investigators
N1 - Funding Information:
The PREDICT Study was funded by the National Health and Medical Research Council of Australia (GNT1132976). Professor Hodgson is supported by a Heart Foundation Fellowship and a National Health and Medical Research Council Investigator Grant (GNT1173271). Professor Gabbe is supported by an Australian Research Council Future Fellowship (FT170100048). The funding agencies had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2021, Springer-Verlag GmbH Germany, part of Springer Nature.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Purpose: This study aimed to determine the prevalence and predictors of death or new disability following critical illness. Methods: Prospective, multicentre cohort study conducted in six metropolitan intensive care units (ICU). Participants were adults admitted to the ICU who received more than 24 h of mechanical ventilation. The primary outcome was death or new disability at 6 months, with new disability defined by a 10% increase in the WHODAS 2.0. Results: Of 628 patients with the primary outcome available (median age of 62 [49–71] years, 379 [61.0%] had a medical admission and 370 (58.9%) died or developed new disability by 6 months. Independent predictors of death or new disability included age [OR 1.02 (1.01–1.03), P = 0.001], higher severity of illness (APACHE III) [OR 1.02 (1.01–1.03), P < 0.001] and admission diagnosis. Compared to patients with a surgical admission diagnosis, patients with a cardiac arrest [OR (95% CI) 4.06 (1.89–8.68), P < 0.001], sepsis [OR (95% CI) 2.43 (1.32–4.47), P = 0.004], or trauma [OR (95% CI) 6.24 (3.07–12.71), P < 0.001] diagnosis had higher odds of death or new disability, while patients with a lung transplant [OR (95% CI) 0.21 (0.07–0.58), P = 0.003] diagnosis had lower odds. A model including these three variables had good calibration (Brier score 0.20) and acceptable discriminative power with an area under the receiver operating characteristic curve of 0.76 (95% CI 0.72–0.80). Conclusion: Less than half of all patients mechanically ventilated for more than 24 h were alive and free of new disability at 6 months after admission to ICU. A model including age, illness severity and admission diagnosis has acceptable discriminative ability to predict death or new disability at 6 months.
AB - Purpose: This study aimed to determine the prevalence and predictors of death or new disability following critical illness. Methods: Prospective, multicentre cohort study conducted in six metropolitan intensive care units (ICU). Participants were adults admitted to the ICU who received more than 24 h of mechanical ventilation. The primary outcome was death or new disability at 6 months, with new disability defined by a 10% increase in the WHODAS 2.0. Results: Of 628 patients with the primary outcome available (median age of 62 [49–71] years, 379 [61.0%] had a medical admission and 370 (58.9%) died or developed new disability by 6 months. Independent predictors of death or new disability included age [OR 1.02 (1.01–1.03), P = 0.001], higher severity of illness (APACHE III) [OR 1.02 (1.01–1.03), P < 0.001] and admission diagnosis. Compared to patients with a surgical admission diagnosis, patients with a cardiac arrest [OR (95% CI) 4.06 (1.89–8.68), P < 0.001], sepsis [OR (95% CI) 2.43 (1.32–4.47), P = 0.004], or trauma [OR (95% CI) 6.24 (3.07–12.71), P < 0.001] diagnosis had higher odds of death or new disability, while patients with a lung transplant [OR (95% CI) 0.21 (0.07–0.58), P = 0.003] diagnosis had lower odds. A model including these three variables had good calibration (Brier score 0.20) and acceptable discriminative power with an area under the receiver operating characteristic curve of 0.76 (95% CI 0.72–0.80). Conclusion: Less than half of all patients mechanically ventilated for more than 24 h were alive and free of new disability at 6 months after admission to ICU. A model including age, illness severity and admission diagnosis has acceptable discriminative ability to predict death or new disability at 6 months.
KW - Disability
KW - Intensive care
KW - Mechanical ventilation
KW - Outcome prediction
KW - Recovery
UR - http://www.scopus.com/inward/record.url?scp=85107569924&partnerID=8YFLogxK
U2 - 10.1007/s00134-021-06438-7
DO - 10.1007/s00134-021-06438-7
M3 - Article
C2 - 34089063
AN - SCOPUS:85107569924
SN - 0342-4642
VL - 47
SP - 772
EP - 781
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 7
ER -