Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Mail Stop F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Intensive Care Med. 2019 Jun;45(6):806-814. doi: 10.1007/s00134-019-05583-4. Epub 2019 Mar 6.
Survivors of critical illness often suffer from reduced health-related quality of life (HRQoL) due to long-term physical, cognitive, and mental health problems, also known as post-intensive care syndrome (PICS). Some intensive care unit (ICU) survivors even consider their state of health unacceptable. The aim of this study was to investigate the determinants of self-reported unacceptable outcome of ICU treatment.
Patients who were admitted to the ICU for at least 48 h and survived the first year after discharge completed validated questionnaires on overall HRQoL and the components of PICS and stated whether they considered their current state of health an acceptable outcome of ICU treatment. The effects of overall HRQoL and components of PICS on unacceptable outcome were studied using multiple logistic regression analysis.
Of 1453 patients, 67 (5%) reported their health state an unacceptable outcome of ICU treatment. These patients had a lower score on overall HRQoL (EQ-5D-index value of 0.57 vs. 0.81; p < 0.001), but we could not determine a cutoff value of the EQ-5D-index value that reliably identified unacceptable outcome. In the multivariate analysis, only the hospital anxiety and depression scale was significantly associated with an unacceptable outcome (OR 2.06, 99% CI 1.18-3.61).
Although there is a strong association between low overall HRQoL and self-reported unacceptable outcome of ICU treatment, patients with low overall HRQoL may still consider their outcome acceptable. The mental component of PICS, but not the physical and cognitive component, is strongly associated with self-reported unacceptable outcome.
危重病幸存者常因长期的身体、认知和心理健康问题（也称为重症监护后综合征）而导致健康相关生活质量（HRQoL）下降。一些重症监护病房（ICU）幸存者甚至认为自己的健康状况无法接受。本研究旨在探讨自我报告的 ICU 治疗结果不可接受的决定因素。
入住 ICU 至少 48 小时并在出院后第一年存活的患者完成了整体 HRQoL 以及 ICU 后综合征（PICS）各组成部分的有效调查问卷，并表示他们是否认为自己目前的健康状况是 ICU 治疗的可接受结果。使用多项逻辑回归分析研究了整体 HRQoL 和 PICS 各组成部分对不可接受结果的影响。
在 1453 名患者中，有 67 名（5%）报告其健康状况是 ICU 治疗的不可接受结果。这些患者的整体 HRQoL 评分较低（EQ-5D 指数值为 0.57，而 0.81；p < 0.001），但我们无法确定 EQ-5D 指数值的截断值能够可靠地识别不可接受的结果。在多变量分析中，只有医院焦虑和抑郁量表与不可接受的结果显著相关（OR 2.06，99%CI 1.18-3.61）。
尽管整体 HRQoL 较低与自我报告的 ICU 治疗结果不可接受之间存在很强的关联，但整体 HRQoL 较低的患者仍可能认为自己的结果是可接受的。PICS 的心理组成部分，而不是身体和认知组成部分，与自我报告的不可接受结果密切相关。
