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

Abstract

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.