Ivo W. Soliman

Single-center large-cohort study into quality of life in Dutch intensive care unit subgroups, 1 year after admission, using EuroQoL EQ-6D-3L ☆

PURPOSE The goal of this study was to describe long-term survival and health-related quality of life (HRQoL), measured by EQ-6D, in a general intensive care unit (ICU) population. MATERIALS AND METHODS We included 5934 consecutive adult patients admitted to a mixed-population ICU. There were no exclusion criteria. One-year survival status was determined using the Dutch municipal population register. Subsequently, all survivors received the EuroQoL EQ-6D-3L questionnaire. The primary outcome was overall HRQoL and survival of the ICU survivors, compared to overall QoL of an age- and sex-matched reference population. RESULTS A total of 5138 patients (86.6%) survived until hospital discharge, with 4647 (78.3%) patients surviving the 1-year of follow-up. The EuroQoL questionnaire was sent to 4465 survivors and returned by 3034 (68.0%) of 4465. The median HRQoL in surviving patients was 0.83 (interquartile range [IQR], 0.64-1.00) vs 0.86 (IQR, 0.85-0.86) in the reference population (P < .001). There was marked variation across admission diagnosis groups: cardiac surgery patients had an HRQoL of 0.94 (IQR, 0.74-1.00), whereas patients admitted with chronic renal failure had an HRQoL of 0.65 (IQR, 0.47-0.83). CONCLUSIONS One year after ICU admission, HRQoL was significantly lower than in the reference population. Notably, marked variations were found across subgroups.

Raising awareness for a low health-related quality of life in intoxicated ICU patients

One of the most important indicators of quality of Intensive Care Unit (ICU) treatment is “ outcome. ” Outcome is defi ned as “ changes in the state of a patient ’ s health that can be attributed to an intervention or to the absence of an intervention. ” Traditionally, physicians have looked at “ in-hospital mortality ” as their most important (and best available) outcome measure. Nowadays, most clinicians realize that long-term survival and health-related quality of life (HRQoL) are equally important or even superior outcome measures. 1

Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome

Background: Sepsis is frequently complicated by the release of cardiac troponin, but the clinical significance of this myocardial injury remains unclear. We studied the associations between troponin release during sepsis and 1-year outcomes. Methods and Results: We enrolled consecutive patients with sepsis in 2 Dutch intensive care units between 2011 and 2013. Subjects with a clinically apparent cause of troponin release were excluded. High-sensitivity cardiac troponin I (hs-cTnI) concentration in plasma was measured daily during the first 4 intensive care unit days, and multivariable Cox regression analysis was used to model its association with 1-year mortality while adjusting for confounding. In addition, we studied cardiovascular morbidity occurring during the first year after hospital discharge. Among 1258 patients presenting with sepsis, 1124 (89%) were eligible for study inclusion. Hs-cTnI concentrations were elevated in 673 (60%) subjects on day 1, and 755 (67%) ever had elevated levels in the first 4 days. Cox regression analysis revealed that high hs-cTnI concentrations were associated with increased death rates during the first 14 days (adjusted hazard ratio, 1.72; 95% confidence interval, 1.14–2.59 and hazard ratio, 1.70; 95% confidence interval, 1.10–2.62 for hs-cTnI concentrations of 100–500 and >500 ng/L, respectively) but not thereafter. Furthermore, elevated hs-cTnI levels were associated with the development of cardiovascular disease among 200 hospital survivors who were analyzed for this end point (adjusted subdistribution hazard ratio, 1.25; 95% confidence interval, 1.04–1.50). Conclusions: Myocardial injury occurs in the majority of patients with sepsis and is independently associated with early—but not late—mortality, as well as postdischarge cardiovascular morbidity.

Correction to: Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

In the original publication Dr Patrick Meybohm of the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt University Hospital, Frankfurt, Germany was inadvertently omitted from the list of investigators.

Intensive care unit length of stay beyond the first week and 1-year mortality - dutch single centre study in unselected critically ill patients describing long-term survival according to length of stay in conjunction with age

Increasing age and prolonged intensive care unit (ICU) length of stay (LoS) are both associated with in-hospital mortality. Especially older patients with a prolonged ICU stay are often considered to be at high risk for mortality.[1] However the effect of a prolonged ICU LoS in conjunction with age on long-term survival remained to be specified.