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Role of preexisting disease in patients' perceptions of health-related quality of life after intensive care.
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jonkoping, Sweden.
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2005 (English)In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 33, no 7, 1557-1564 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To find out how patients perceive their health-related quality of life after they have been treated in an intensive care unit and whether preexisting disease influenced their perception.

DESIGN:: Follow-up, quantitative, dual-site study.

SETTING: Combined medical and surgical intensive care units of one university and one general hospital in Sweden.

PATIENTS: Among the 1,938 patients admitted, 562 were considered eligible (>24 hrs in the intensive care unit, and age >18 yrs). The effect of preexisting disease was assessed by use of a large reference group, a random sample (n = 10,000) of the main intake area of the hospitals.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: During 2000-2002, data were collected from the intensive care unit register and from a questionnaire mailed to the patients 6 months after their discharge from hospital. Subjects in the reference group were sent postal questionnaires during 1999. Of the patients in the intensive care unit group, 74% had preexisting diseases compared with 51% in the reference group. Six months after discharge, health-related quality of life was significantly lower among patients than in the reference group. When comparisons were restricted to the previously healthy people in both groups, the observed differences were about halved, and when we compared the patients in the intensive care unit who had preexisting diseases with subjects in the reference group who had similar diseases, we found little difference in perceived health-related quality of life. In some dimensions of health-related quality of life, we found no differences between patients in the intensive care unit and the subjects in the reference population.

CONCLUSIONS: Preexisting diseases significantly affect the extent of the decline of health-related quality of life after critical care, and this effect may have been underestimated in the past. As most patients who are admitted to an intensive care unit have at least one preexisting disease, it is important to account for these effects when examining outcome.

Place, publisher, year, edition, pages
2005. Vol. 33, no 7, 1557-1564 p.
Keyword [en]
health-related quality of life, intensive care, comorbidity, treatment outcome, control group, subgroup comparison
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17824DOI: 10.1097/01.CCM.0000168208.32006.1CPubMedID: 16003062OAI: oai:DiVA.org:liu-17824DiVA: diva2:212374
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Health related quality of life in adult former intensive care unit patients
Open this publication in new window or tab >>Health related quality of life in adult former intensive care unit patients
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients treated in an intensive care unit (ICU) are seriously ill, have a high co‐morbidity, morbidity and mortality. ICUs are resource – demanding as they consume significant hospital resources for a minority of patients. The development of new medical procedures for critical care patients has over the years led to survival of larger numbers with more complex illnesses and extensive injuries. Improved survival rates lead to needs for outcome measures other than survival. The present study examines health‐related quality of life (HRQoL) and factors assumed to be important for the long term HRQoL for former ICU patients.

Methods: This is a multicenter cohort study of 980 adult patients admitted to one of three mixed medical‐surgical ICUs in Southern Sweden, during 2000 to 2004. The patients were studied at four different occasions after their critical illness: 6, 12, 24, and 36 months after discharge from the ICU and hospital. HRQoL was assessed by the EuroQol 5‐Dimensions (EQ‐5D) and Medical Outcome Short Form (SF‐36), sleep disturbances by the Basic Nordic Sleep questionnaire (BNSQ), and pre‐existing diseases was collected by self‐reported disease diagnosis. Data from a large public health survey (n=6093) of the county population were used as reference group.

Results: Compared with the age and sex adjusted general reference group the patients who had been in the ICU had significantly lower scores on EQ‐5D and in SF‐ 36 all eight dimensions. This was seen both for the general ICU patients as well as for the multiple trauma patients. Significant improvement over time was seen only in single and separate dimensions for the general ICU group, and for the multiple trauma group. Long term effects of ICU care on sleep patterns were found minor as 70 % reported an unchanged sleep pattern and only 9% reported worse sleep after the IC period. Pre‐existing diseases were found to be the factor that had the largest influence on HRQoL in both the short‐ and long term perspective for the general ICU patients as well as for the multiple trauma patients. It was also found to have negative impact on sleep. IC ‐related factors showed only a minor influence on HRQoL or sleep patterns after the ICU stay.

Conclusions: This multicenter study shows that pre‐existing diseases influence the HRQoL short‐ and long‐term after IC, and it must be accounted for when HRQoL and outcome after IC are studied. Approximately, 50% of the decline in HRQoL for the ICU patients could be explained by pre‐existing diseases. Future research needs to focus on the remaining factors of importance for the total HRQoL impairment for these patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1117
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17829 (URN)978‐91‐7393‐651‐4 (ISBN)
Public defence
2009-05-08, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
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Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2012-01-26Bibliographically approved

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Orwelius, LottiNordlund, AndersEdéll-Gustafsson, UllaKristenson, MargaretaBendtsen, PrebenSjöberg, Folke

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