An unavoidable question in Intensive Medical Care is how many improve or recover the quality of life they had prior to admission to an Intensive Medical Care Unit (ICU) and how many disimprove and to what degree.

Quality of life prior to and that expected after release from hospital is one of the factors most taken into account by professionals on admitting a patient into an Intensive Medical Care Unit. This is the case because the mission of medics at ICUs is not just to return the patients alive to the ward, but to restore them to the same or a better level of health and quality of life they had prior to admission, and to be able to maintain this situation over a reasonable period of time in order to justify the human and financial costs that an ICU generates.

In this context it would not appear to be sufficient to talk about results in terms of mortality; it is also necessary to know the prognosis of the patient. Sebastián Iribarren Diarasarri’s PhD thesis takes on board both. His work is entitled, Mortality and health-related quality of life amongst patients admitted to Intensive Medical Care Units.

Mortality and quality of life

The objectives of this research work are: the study of mortality rate; to determine if critical patients suffer a deterioration in their quality of life six months after being released from hospital and in what aspects thereof; and identifying the variables associated with the variations in the quality of life related to health.

With the aim of finding answers to these questions, Mr Iribarren drew up a study with a group of patients. To this end, 377 patients admitted to the ICU at Txagorritxu Hospital (Vitoria-Gasteiz) in 1999-2000 were monitored one year after release.

He registered variables linked to chronic pathologies, the gravity of the patient’s condition in their stay at the ICU, the therapeutic effort undertaken, etc. He undertook a questionnaire on health-linked quality of life on admission to the Unit in order to find out the prior state. He repeated the questionnaire after 6 months from hospital release.

According to the results obtained, the hospital death rate amongst the group of patients was 24.9% and, after a year, the rate was 40.8%. The hospital death rate was associated with a previous hospital stay in the ICU greater than two days, with the seriousness of the illness that precipitated admission to the ICU, etc. Quality of life related to previous health is a factor independent of hospital death rate.

Mr Iribarren observed that there was a statistically significant clinical deterioration in health-related quality of life six months after release from the ICU in 60% of patients, particularly affecting everyday activities (work, walking, ability to make movement efforts, etc.). Nevertheless, most patients continue to be self-sufficient.

He concluded that the deterioration in health-related quality of life is more notable in those who are admitted having suffered multiple injuries, renal failure or undergo a stay in the ICU of more than 10 days. However, those with a prior highly deteriorated quality of life or who have had chronic illnesses show less deterioration in their quality of life.

Source: Irati Kortabitarte
Elhuyar Fundazioa