Table 2.
Patient characteristics for the included studies
| Reference | Country | Study design | Population | n | Age Mean (SD) | Males n (%) | Disease severity Mean (SD) | ICU diagnosis n (%) | Quality of life |
|---|---|---|---|---|---|---|---|---|---|
| Hofhuis et al.(10) | Holland | Prospective 6-month follow-up study | Patients admitted for longer than 48 hours | 749 | ≥ 80 years (n = 129) | 72 (56) | APACHE II: 20 (17 - 24) | Cardiovascular: 34 (26) versus 146
(24) Respiratory: 35 (27) versus 211 (34) Gastrointestinal: 55 (43) versus 207 (33) Neurological: 1 (1) versus 29 (5) Trauma: 2 (2) versus 21 (3) Others: 2 (2) versus 6 (1) |
Most SF-36 dimensions significantly improved over time. Among the octogenarians, the mean SF-36 dimensions 6 months after ICU discharge were similar to the basal and were not significantly lower than those of the normal population |
| < 80 years (n = 620) | 385 (62) | APACHE II: 18 (14 - 23) | |||||||
| van den Boogaard et al.(11) | Holland | Prospective 18-month follow-up study | Patients with and without delirium, ICU survivors | 915 | Patients with delirium: 65 (58 - 75) | 101 (60) | APACHE II: 17 (14 - 20) | Surgical: 77 (45) versus 589 (79)
Clinical: 54 (32) versus 77 (10) Trauma: 17 (10) versus 24 (3) Neurological: 23 (14) versus 54 (7) |
Patients with delirium during the ICU stay had a similar adjusted HRQOL evaluation, albeit with significantly more cognitive problems than patients without delirium |
| Patients without delirium: 65 (57 - 72) | 508 (68) | APACHE II: 13 (10 - 16) | |||||||
| Vaara et al.(12) | Finland | 6-month observational retrospective cohort study | ICU patients treated with RRT or not | 24,904 | Patients treated with RRT: 63 (52 - 72) | 1,143 (67.8) | SAPS II: 48 (37 - 62) | Cardiovascular: 330 (20) versus 6,058
(26) Gastrointestinal: 286 (17) versus 3,628 (16) Neurological: 103 (6) versus 4,483 (19) Renal: 269 (16) versus 383 (2) Respiratory: 159 (9) versus 3,135 (13) Trauma: 36 (2) versus 1,534 (7) Others: 467 (28) versus 3,431 (15) |
No clinically significant difference in EQ-5D score was found between patients treated with and without RRT after 6 months of follow up. In addition, a VAS of patients treated with RRT matched the score of patients treated without RRT and that of the general population |
| Patients treated without RRT: 62 (50 - 73) | 14,641 (63.1) | SOFA: 10 (7 - 13) | |||||||
| SAPS II: 33 (23 - 46) | |||||||||
| SOFA: 6 (3 - 8) | |||||||||
| Pavoni et al.(13) | Italy | 1-year observational prospective cohort study | Patients aged 80 years or older | 288 | Clinical: 87 (2) | 77 (27) | Clinical SAPS II: 52.3 (8.8) | Clinical: 54 (19) | The HRQOL of clinical and orthopedic elderly patients was worse than the HRQOL of surgical patients and of the normal population 1 year after ICU hospitalization |
| Planned abdominal surgery: 87 (1.5) | Planned abdominal surgery (AS): 30.2 (5.4) | Surgical: 74 (26) | |||||||
| Unplanned abdominal surgery: 88 (2.2) | Unplanned AS: 46.5 (6.2) | Orthopedic: 160 (55) | |||||||
| Orthopedic surgery: 85.9 (4.2) | Orthopedic surgery: 24.2 (7.2) | ||||||||
| Orwelius et al.(14) | Portugal | Prospective, multicenter, 6-month follow-up study | Adults ≥ 18 years with ICU stay > 48 hours | 313 | With community-acquired sepsis: 60 (50 - 70) | 59 (65) | SAPS II (IQR): 41 (34 - 51) | Noncoronary: 69 (76) versus 95 (43)
Coronary: 1 (1) versus 12 (5) Trauma: 3 (3) versus 46 (21) Elective surgery: 0 (0) versus 35 (16) Nonelective surgery: 18 (20) versus 34 (15) |
The long-term HRQOL of patients with community-acquired sepsis were not significantly different compared with ICU patients admitted for other diagnoses. However, when compared with the general population, the HRQOL of patients with sepsis showed a clinically significant decrease |
| Without community-acquired sepsis: 59 (43 - 71) | 124 (56) | SAPS II (IQR): 35 (27 - 44) | |||||||
| Wolters et al.(15) | Holland | 1-year prospective observational cohort study | Patients hospitalized at the ICU for longer than 24 hours | 1,101 | Patients with delirium: 60.5 (16.7) | 271 (66) | APACHE IV: 73.7 (28.3) | Clinical: 222 (54) versus 208 (30)
Elective surgery: 96 (23) versus 351 (51) Acute surgery: 94 (23) versus 130 (19) |
Delirium during ICU stay is not independently associated with the HRQOL of ICU survivors when adjusted for factors such as severity of illness during ICU stay |
| Patients without delirium: 59.4 (16.6) | 406 (59) | APACHE IV: 53.9 (22.4) | |||||||
| Oeyen et al.(16) | Belgium | 4-year prospective observational cohort study | Patients admitted to the ICU with AKI treated with RRT matched with patients without AKI-TRS | 141 | Patients with AKI-RRT: 57 (45 - 69) | 31 (66) | APACHE II: 26 (21 - 31) | Clinical: 32 (68) versus 67 (71)
Elective surgery: 1 (2) versus 4 (4) Emergency surgery: 10 (21) versus 18 (19) Trauma: 3 (6) versus 4 (4) Burn: 1 (2) versus 1 (1) |
The long-term QOL of survivors of critical illness with AKI-RRT was similar to that of patients without AKI-RRT, albeit lower than that of the general population |
| Patients without AKI-RRT: 57 (48 - 70) | 62 (66) | APACHE II: 24 (20 - 30) | |||||||
| Soliman et al.(17) | Holland | 1-year prospective cohort study | All ICU patients | 5,934 | 64 (52 - 73) | 3.710 (62) | APACHE IV: 49 (35 - 68) | Heart surgery: 2.162 (36) Sepsis: 556 (9) Subarachnoid hemorrhage: 359 (6) Traumatic brain injury: 327 (6) Others: 2.530 (43) |
The HRQOL 1 year after ICU hospitalization was significantly lower than that of the sex- and aged-matched general population. However, the 1-year HRQOL markedly varied by ICU survivor subgroup |
| Hofhius et al.(18) | Holland | 5-year prospective cohort study | ICU Patients for longer than 48 hours | 749 | 71 (62 - 77) | 457 (61) | APACHE II: 19 (14 - 23) | Cardiovascular: 184 (25) Respiratory: 244 (33) Gastrointestinal: 259 (35) Neurological: 30 (4) Trauma: 23 (3) Others: 9 (1) |
After correcting for natural decline, the HRQOL significantly decreased, and the physical functioning, social functioning and general health dimensions remained significantly lower than those of the age-matched general population, albeit with small effect sizes |
| Cuthbertson et al.(19) | Scotland | 5-year, multicenter, prospective cohort study | Patients with severe sepsis | 439 | 58 (45 - 67) | 234 (53) | APACHE II: 23 (17 - 28) | Respiratory: 138 (31)
Cardiovascular: 124 (28) Neurological: 44 (10) Gastrointestinal: 93 (21) Other: 26 (7) Unknown: 14 (3) |
Patients with severe sepsis have a significantly lower physical dimension of HRQOL than the normal population, although the mental dimension was slightly lower than the normative data up to 5 years after severe sepsis |
| SAPS II: 41 (30 - 54) | |||||||||
| Battle et al.(20) | United Kingdom | 2-year, observational, prospective cohort study | Patients with sepsis | 50 Group SIRS: (n = 19) | 58 (30) | 23 (46) | SOFA: 3 (4) | Respiratory: 18 (36)
Gastrointestinal: 9 (18) Neurological: 1 (2) Endocrine: 10 (20) Renal: 8 (16) Others: 4 (8) |
The HRQOL of patients with sepsis was significantly lower than local, normative data. More significant decreases in HRQOL were found in patients with septic shock than in patients with SIRS and sepsis |
| Group sepsis: (n = 16) | Charlson Comorbidity Index: 3 (4) | ||||||||
| Septic shock group: (n = 15) | |||||||||
| Honselmann et al.(21) | Germany | 1-year retrospective cohort study | Patients with pneumonia and/or sepsis | 217 | 71 (62 - 78) | 134 (62) | SAPS II: 36 (28 - 50) | Sepsis: 145 (67) Pneumonia: 72 (33) Sepsis and pneumonia: 99 (46) |
The HRQOL of patients with pneumonia and/or sepsis was significantly lower than that of the local reference group |
| Fan et al.(22) | United States | 2-year, multisite, prospective study with longitudinal follow-up | Patients under MV with ALI | 222 | 49 (40 - 58) | 123 (55) | APACHE II: 23 (19 - 28) | Pneumonia: 112 (50) Sepsis: 44 (20) Aspiration: 29 (13) Trauma: 7 (3) Others: 30 (14) |
The physical function was substantially impaired, when compared with the corresponding population in all time points (3, 6, 12 and 24 months), and remained markedly impaired in relation to baseline values estimated before ALI (72% baseline value at 24 months of follow-up), according to the SF-36 questionnaire |
| Heyland et al.(23) | Canada | 1-year multicenter, prospective, observational cohort study | Patients aged 80 years or older admitted to the ICU for less than 24 hours | 610 | 84 (80 - 99) | 338 (55) | APACHE II: 22 (7 - 49) | Cardiovascular: 94 (15) Respiratory: 94 (15) Sepsis: 135 (22) Gastrointestinal: 110 (18) CVA: 27 (4) Neurological: 20 (3) Trauma: 46 (8) Metabolic: 8 (1) Hematological: 18 (3) ABG/ valve replacement: 49 (8) Renal: 2 (0) Gynecological: 1 (0) Orthopedic: 6 (1) |
Octogenarian ICU survivors had significantly lower SF-36 scores in the physical functioning section than those of sex- and age-matched controls in all time points (3, 6, 9 and 12 months). A quarter of them returned to baseline levels of physical functioning at 12 months |
| Bagshaw et al.(24) | Canada | 1-year multicenter, prospective, observational cohort study | ICU patients aged 50 years or older for more than 24 hours | 421 | Frail: 69 (10.1) | 72 (52) | APACHE II 21.3 (6.5) | Surgery: 34 (26) versus 108 (38)
Cardiac arrest: 10 (7) versus 21 (7) Mechanical ventilation: 122 (88) versus 240 (85) Vasoactive drug therapy: 83 (60) versus 146 (52) Renal replacement therapy: 14 (10) versus 33 (12) |
12 months after critical illness, frail patients had a worse HRQOL, both in the EuroQol and in the SF-12 , than nonfrail survivors and the general population |
| Not frail: 66.2 (9.7) | 186 (66) | APACHE II 18.6 (7.1) | |||||||
| Feemster et al.(25) | United States | 1-year prospective, observational cohort study | All patients who visited their primary care unit at least once in the previous year | 11,243 | Outpatient: 64.8 (10.8) | 8.929 (97) | - | Hospital and ICU patients showed clinically significant decreases in SF-36 sections, albeit small and similar between both groups | |
| Hospital patient: 66.0 (10.7) | 1.297 (96) | ||||||||
| ICU patient: 66.8 (9.4) | 649 (97) | ||||||||
| McKinley et al.(26) | Australia | 6-month prospective, observational cohort study | Adult patients subjected to MV for longer than 24 hours and who stayed at the ICU for longer than 48 hours | 195 | 57 (16) | 116 (59) | APACHE II: 18.8 (6.9) | Cardiovascular: 38 (20) Respiratory: 46 (24) Gastrointestinal: 57 (30) Others: 50 (26) |
The mental health score of the SF-36 at 1 week was lower than the mean score of the age-matched population, although it improved within 8 to 26 weeks after hospital discharge |
| McKinley et al.(27) | Australia | 6-month prospective, observational cohort study | Adult ICU patients for longer than 48 hours | 222 | 57.2 (17.2) | 145 (65) | - | Cardiovascular: 81 (37) Respiratory: 13 (6) Gastrointestinal: 20 (9) Neurological: 57 (26) Trauma: 24 (11) Sepsis: 5 (2) Others: 22 (10) |
The mental health and physical functioning scores of the SF-36 were significantly lower in patients with poor sleep quality 6 months after ICU discharge |
| Zhang K et al.(28) | China | 6-year, multicenter, prospective case-control study | Adults, ≥ 18 years, who stayed at the ICU for longer than 24 hours | 224 | Sepsis group: 53 (17.3) | Sepsis group: 32 (76) | APACHE II: 18.3 (6.8) | Cardiovascular: 14 (33) versus 9 (27)
Respiratory: 22 (52) versus 12 (36) Renal: 12 (28) versus 9 (27) Hematological: 9 (21) versus 5 (15) Neurological: 23 (54) versus 16 (48) |
No difference in HRQOL was found between the sepsis and the control groups of critically ill patients. However, when compared the community control group, the patients with severe sepsis showed clinically significant impairment in 4 of the 8 domains of the SF-36 6 years after hospital discharge |
| Control group: 47 (18.1) | Control group: 23 (70) | APACHE II: 13.7 (6.5) | |||||||
| Das Neves et al.(29) | Argentina | 1-year, prospective, observational cohort study | Patients aged 15 years or older who remained under MV for longer than 48 hours | 112 | 33 (24 - 49) | 76 (68) | APACHE II: 15 (6) | Trauma: 56 (50) Traumatic brain injury: 46 (41) Medical: 32 (29) Emergency surgery: 15 (13) Elective Surgery: 9 (8) |
The patients showed high and persistent critical illness burden, severely affecting their HRQOL, which was adversely affected by events such as shock, MV duration and persistent weakness |
| Contrin et al.(30) | Brazil | 1-year, nested case-control study | Patients with severe sepsis | 100 | Control group: 52.2 (19.4) | 24 (48) | _ | Respiratory: 4 (8) versus 11 (22)
Urinary: 3 (6) versus 5 (10) Cardiovascular: 3 (6) versus 4 (8) Nervous: 9 (18) versus 5 (10) Trauma: 6 (12) versus 10 (20) Gastrointestinal: 12 (24) versus 4 (8) Neoplasia: 10 (20) versus 4 (8) Sepsis: 2 (4) versus 1 (2) Metabolic: 0 (0) versus 2 (4) Postoperative: 1 (2) versus 4 (8) |
Elderly patients with sepsis had more moderate and severe problems in all five dimensions of the HRQOL studied than critically ill patients without sepsis |
| Sepsis group: 51.3 (20.0) | 32 (64) | _ |
SD – standard deviation; ICU – intensive care unit; APACHE – Acute Physiology and Chronic Health Evaluation; SF-36 – Medical Outcomes Study 36 - Item Short - Form Health Survey; HRQOL – health-related quality of life; RRT – renal replacement therapy; SAPS – Acute Physiology Score; SOFA – Sequential Organ Failure Assessment; EQ-5D – EuroQol Health Questionnaire; VAS – visual analog scale; IQR – interquartile range; AKI – acute kidney injury; QOL – quality of life; SIRS – systemic inflammatory response syndrome; MV – mechanical ventilation; ALI – acute lung injury; CVA – cerebrovascular accident (stroke); SF-12 – 12-Item Short-Form Health Survey.