Poor pre-ICU functional status associated with post-ICU mortality

1. In a cohort of elderly adults more than 70 years of age admitted to an ICU, more than half of all patients experienced functional decline or early death after critical illness.

2. Functional status characterized as mild to moderate and severe disability prior to ICU admission were associated with double and triple risk of death within 1 year of ICU admission, respectively.

Evidence Rating Level: 2 (Good)

Study Rundown: The elderly make up a significant proportion of ICU admissions. However, the impact of functional status prior to ICU admission on a patient’s trajectory of recovery is unclear. This study aimed to detail the functional trajectories before and after an ICU admission in the elderly and determine if there is any association to short-term and long-term mortality. The authors found that worse pre-ICU functional status was associated with functional decline and increased risk of death within 1 year of critical illness. Lower functional status prior to critical illness was associated with increased likelihood of transitioning to a worse disability status.

Strengths of this study include being the first prospective cohort study with robust monthly functional evaluations to assess pre- and post-ICU functional status. Other strengths include advanced age of study population allowing for novel information on disability courses and increased external validity due to including a wide-range of ICU settings. However, limitations of this study include the small number of ICU admissions resulting in a small sample size.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Functional disability 5 years after Acute Respiratory Distress Syndrome

In-Depth [prospective cohort]: This prospective cohort study used participants from the Precipitating Events Project, a cohort including 754 initially non-disabled, community-dwelling people aged 70 and older, assembled from 1998-1999. A total of 291 patients were included in the study, who had at least one ICU admission from enrollment through 2011. Disability status was determined at baseline and monthly thereafter until December 2012 by interviews on basic, instrumental and mobility activities. Participants were divided into three baseline functional trajectories: minimal (29.6%), mild to moderate (44%) and severe disability (26.4%). Comprehensive ICU admission information was determined by Medicare claims data and medical record review.

Of the 291 participants, 70 experienced death within hospital, or after discharge but within 30 days of admission. About 53.4% of all patients experienced significant functional decline over the following year or early death within one month after critical illness. After ICU admission, 18.2% had minimal disability, 26.6% had mild to moderate disability, and 46.9% had severe disability. One-year mortality was 43.0% (95%CI 37.3%-48.7%) and increased with worsening pre-ICU functional status. Relative to minimal pre-ICU disability, mild to moderate and severe disability were associated with double (aHR 2.41, 95%CI 1.29-4.50) and quadruple (aHR 3.84, 95% CI 1.84-8.03) risk of death within 1 year of critical illness, respectively.

Image: PD

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.