Determinants of Subjective Mental and Functional Health of Critical Illness Survivors: Comparing Pre-ICU and Post-ICU Status.

Objectives: To compare ICU survivors' subjective mental and functional health before ICU admission and after discharge and to assess determinants of subjective health decline or improvement.
Design: Secondary analysis of the multicenter cluster-randomized Enhanced Recovery after Intensive Care trial ( ClinicalTrials.gov : NCT03671447).
Setting: Ten ICU clusters in Germany.
Patients: Eight hundred fifty-five patients with 1478 follow-up assessments.
Interventions: None.
Measurements and Main Results: At two patient follow-ups scheduled 3 and 6 months after ICU discharge, patients rated their subjective mental and functional/physical health on two separate visual analog scales from 0 (worst) to 10 (best) in the previous week and before ICU admission. We compared pre-ICU and post-ICU subjective health and used mixed-effects regression to assess determinants of a health decline or improvement. At the first follow-up, 20% ( n = 165/841) and 30% ( n = 256/849) of patients reported a decline in subjective mental and functional health of at least three points, respectively; 16% ( n = 133/841 and n = 137/849) outlined improvements of mental and functional health. For 65% ( n = 543/841) and 54% ( n = 456/849), mental and functional health did not change three points or more at the first follow-up. Multivariable mixed-effects logistic regressions revealed that the ICU length of stay was a predictor of mental (adjusted odds ratio [OR] per ICU day, 1.04; 95% CI, 1.00-1.09; p = 0.038) and functional health (adjusted OR per ICU day, 1.06; 95% CI, 1.01-1.12; p = 0.026) decline. The odds of a mental health decline decreased with age (adjusted OR per year, 0.98; 95% CI, 0.96-0.99; p = 0.003) and the odds of a functional health decline decreased with time after discharge (adjusted OR per month, 0.86; 95% CI, 0.79-0.94; p = 0.001).
Conclusions: The majority of ICU survivors did not experience substantial changes in their subjective health status, but patients with long ICU stays were prone to subjective mental and functional health decline. Hence, post-ICU care in post-ICU clinics could focus on these patients.
Competing Interests: Drs. Paul’s, Cittadino’s, Spies’s, and Weiss’s institution received funding from the German Innovation Fund of the Federal Joint Committee during the conduct of the study. Outside the submitted work, Dr. Paul reports financial support for attending meetings and travel from Teladoc Health. Dr. Spies’ institution received funding from the Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)/German Aerospace Center and the Einstein Stiftung Berlin/Einstein Foundation Berlin; she disclosed Inner University Grants, grants from Projektträger im Deutsches Zentrum für Luft- und Raumfahrt e. V., Project Management Agency, grants from Stifterverband, Nonprofit Society Promoting Science and Education, grants from European Society of Anaesthesiology and Intensive Care, grants from the Federal Ministry for Economic Affairs and Climate Action, personal fees from Georg Thieme Verlag, grants from Dr. Franz Köhler Chemie GmbH, grants from Sintetica GmbH, grants from Max-Planck-Gesellschaft zur Förderung der Wissenschaften e. V., grants from Stifterverband für die deutsche Wissenschaft e. V., Metronic, grants from Philips Electronics Nederland BV, grants from Federal Ministry of Education and Research (BMBF), grants from BMBF/Robert Koch Institute (RKI), and grants from Deutsche Forschungsgemeinschaft/German Research Society; she disclosed ownership of patent 15753 627.7 issued in Europe (Germany/Austria/Switzerland/Liechtenstein/France/United Kingdom/The Netherlands) as inventor, a U.S. patent PCT/EP 2015/067731 issued as inventor, a patent 3 174 588 issued in Europe (Germany/Switzerland/Liechtenstein/France/The Netherlands) as inventor, an international patent 10 2014 215 211.9 licensed, an international patent 10 2018 114 364.8 licensed, an international patent 10 2018 110 275.5 licensed, an international patent 50 2015 010 534.8 licensed, an international patent 50 2015 010 347.7 licensed, and an international patent 10 2014 215 212.7 licensed; she disclosed an unpaid role in the Association of the Scientific Medical Societies in Germany, an unpaid role in the German Research Foundation review boards, and an unpaid membership role in the German National Academy of Sciences—Leopoldina. Dr. Weiss’ institution received funding from the Federal Joint Committee (Enhanced Recovery after Intensive Care 01NVF16011); he received funding from the German Ministry of Health, Orion Pharma, Dr. Franz Köhler Chemie, and Teladoc Health GmbH; he disclosed participation on the Delirium-Task-Force Advisory Board of the European Society of Intensive Care Medicine; and he disclosed position as regional chair of the state of Berlin of the German Society of Anesthesiology and Intensive Care. The remaining authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)