Health-related quality of life of patients with multiple organ dysfunction: Individual changes and comparison with normative population

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Abstract

Objective

To determine health-related quality of life in medical intensive care patients with multiple organ dysfunction.

Design

Prospective, observational study.

Setting

A 12-bed, noncoronary, medical intensive care unit of a university hospital.

Patients

Between June 1998 and May 1999, 318 consecutively admitted adult patients with an intensive care unit stay of >24 hrs were studied.

Measurements and Main Results

Health-related quality of life was assessed using a generic instrument, the Medical Outcomes Study Short Form-36 Health Survey, at admission and at 6-month follow-up. Patients who developed multiple organ dysfunction (n = 170) consumed 85% of the therapeutic activity provided in the intensive care unit. Compared with age- and sex-adjusted general population controls, multiple organ dysfunction patients had a worse preadmission health-related quality of life than other intensive care unit patients, predominantly due to a higher burden of comorbid disease. In a multivariate analysis, multiple organ dysfunction was the only variable independently associated with deteriorated physical health domains at follow-up (odds ratio, 4.4; 95% confidence interval, 1.3–14.6;p = .015), but it had no impact on dimensions of mental health. Analyzing the impact of different organ system failures, respiratory failure (odds ratio, 4.1; 95% confidence interval, 1.6–10.3;p = .002) and acute renal failure (odds ratio, 3.3; 95% confidence interval, 1.0–11.5;p = .05) increased the risk of deteriorated physical health at follow-up. No impact of the various organ system failures on mental health was noted. At 6-month follow-up, 83–90% of survivors had regained their previous health-related quality of life, and 94% were living at home with their families.

Conclusions

This study has shown that preadmission health-related quality of life of our medical, noncoronary patients was substantially reduced compared with a matched general population. This demonstrates the need to take prehospitalization health-related quality of life into account when examining the outcomes of intensive care unit survivors. Multiple organ dysfunction was the major determinant of poor physical health at follow-up, but it had no impact on mental health domains.

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