Quality of life in the five years after intensive care: a cohort study

Brian H Cuthbertson, Siân Roughton, David Jenkinson, Graeme Maclennan, Luke Vale, Brian H Cuthbertson, Siân Roughton, David Jenkinson, Graeme Maclennan, Luke Vale

Abstract

Introduction: Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge.

Methods: A prospective longitudinal cohort study in a University Hospital in the UK. Quality of life was assessed from the period before ICU admission until 5 years and quality adjusted life years calculated.

Results: 300 level 3 intensive care patients of median age 60.5 years and median length of stay 6.7 days, were recruited. Physical quality of life fell to 3 months (P = 0.003), rose back to pre-morbid levels at 12 months then fell again from 2.5 to 5 years after intensive care (P = 0.002). Mean physical scores were below the population norm at all time points but the mean mental scores after 6 months were similar to those population norms. The utility value measured using the EuroQOL-5D quality of life assessment tool (EQ-5D) at 5 years was 0.677. During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001).

Conclusions: Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support.

Figures

Figure 1
Figure 1
Study recruitment and retention, measured death rates and loss to follow up at each time point up to five years. ICU = intensive care unit.
Figure 2
Figure 2
Kaplan-Meier survival estimates for study patients who were available for follow up over the five years after ICU discharge (solid line). Patients are censored throughout period due to loss to follow up. Age- and sex-matched survival for UK general population is also shown (dotted line). ICU = intensive care unit.
Figure 3
Figure 3
Differences in physical component score between time points for all study patients. The mean score at each stage is plotted with the bars representing one standard error. The means at three months and five years are significantly lower than the mean at the pre-morbid point (P = 0.003 and 0.024, respectively), but means at the other three time points are not significantly different from pre-morbid. The physical component score falls from 2.5 to 5 years (P = 0.002).
Figure 4
Figure 4
Differences in mental component score between time points for all study patients. The mean score at each stage is plotted with the bars representing one standard error. The mean mental component score at the pre-morbid point is significantly lower than the mean scores at all of the other time points (all P < 0.001).
Figure 5
Figure 5
Cumulative mean quality adjusted life year (QALYs) in ICU survivors up to five years after ICU discharge (solid line) compared to normal population (dotted line). After five years the ICU cohort has accumulated significantly less QALYs (P < 0.001) than the age- and sex-matched cohort of the general population. ICU = intensive care unit.

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