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Vol. 47. Issue 9.
Pages 493-500 (September 2023)
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Vol. 47. Issue 9.
Pages 493-500 (September 2023)
Original article
Post-intensive care syndrome one month after discharge in surviving critically ill COVID-19 patients
Síndrome post-cuidados intensivos al mes del alta hospitalaria de pacientes críticos supervivientes a COVID 19
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S. Iribarren-Diarasarria,b,
Corresponding author
, C. Bermúdez-Ampudiab, R. Barreira-Mendeza, A. Vallejo-Delacuevac, I. Bediaga-Díazdecerioc, S. Martinez-Alútiza, L. Ruilope-Alvaroa, C. Vinuesa-Lozanoa, N. Aretxabala-Cortajarenaa, A. San Sebastián-Hurtadoa, M. Martín-Martíneza, I. Arce-Gómezc
a Unidad de Gestión Clínica de Medicina y Cuidados Intensivos, Hospital Universitario Araba, Sede Txagorritxu, Osakidetza, Vitoria-Gasteiz, Spain
b Bioaraba Health Research Institute, Epidemiology and Public Health Group, Vitoria-Gasteiz, Spain
c Unidad de Gestión Clínica de Medicina y Cuidados Intensivos, Hospital Universitario Araba, Sede Santiago, Osakidetza, Vitoria-Gasteiz, Spain
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Tables (3)
Table 1. Descriptive and clinical data of the study cohort.
Table 2. Bivariate analysis according to the decrease in Health Index (≥10%).
Table 3. Univariate analysis according to the decrease in Health Index (≥10%).
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Abstract
Objectives

Incidence of post-intensive care syndrome at one month after hospital discharge in surviving critically ill COVID 19 patients and to identify associated factors.

Design

Prospective cohort study.

Setting

Two multipurpose critical care units of the Araba University Hospital. Patients admitted to critical care units for severe acute respiratory failure secondary to COVID 19.

Intervention

None.

Variables of interest

Demographic variables, length of stay, Charlson index, APACHE II, SOFA, days of mechanical ventilation, tracheotomy, delirium, tetraparesis of the critical patient, EuroQol 5D5L, Minimental Test.

Results

A deterioration in the EuroQol health index (HI) from 90.9±16.9 to 70.9±24.7 (p<0.001) was observed. The impairment of the five EuroQol domains is: mobility (46.1%), usual activities (44.7%), discomfort/pain (30.7%), psychological domain (27.3%) and self-care (20.3%). The 61.5% suffer a significant decrease in their health index. Multivariate analysis by logistic regression shows us that delirium (OR=3.01; 95%CI: 1.01–8.9; p=0.047) and tracheostomy (OR=2.37; 95%CI: 1.09–5.14; p=0.029) show association with drop in EuroQoL 5D5L SI. The area under the ROC curve of the model is 67.3%, with a confidence interval between 58% and 76%. The model is calibrated using the Hosmer-Lemeshow test (χ2=0.468; p=0.792). Only 1.2% of patients showed a score ≤ 24, clearly pathological, on the Folstein's Minimental Test.

Conclusions

Delirium and need for tracheostomy are associated with post-intensive care syndrome assessed by EuroQol 5D5L.

Keywords:
Health-related quality of life
EuroQol 5D5L
Post-intensive care syndrome
COVID 19
Resumen
Objetivos

Incidencia del síndrome post-cuidados intensivos al mes del alta hospitalaria en pacientes críticos supervivientes de COVID 19 e identificar factores asociados.

Diseño

Estudio de cohortes prospectivo.

Ámbito

Dos unidades de críticos polivalentes del Hospital Universitario Araba. Pacientes ingresados en unidades de críticos por insuficiencia respiratoria aguda grave secundaria a COVID 19.

Intervención

Ninguna.

Variables de interés

Variables demográficas, estancias, índice de Charlson, APACHE II, SOFA, días de ventilación mecánica, traqueotomía, delirio, tetraparesia del paciente crítico, EuroQol 5D5L, Minimental Test.

Resultados

Se objetiva un deterioro en el índice de salud (IS) del EuroQol que pasa de 90,9±16,9 a 70,9±24,7 (p<0,001). La afectación de los cinco dominios del EuroQol es de: movilidad (46,1%), actividades habituales (44,7%), malestar/dolor (30,7%), dominio psicológico (27,3%) y autocuidado (20,3%). El 61,5% sufren un descenso significativo de su índice de salud. El análisis multivariante mediante regresión logística nos muestra que el delirio (OR=3,01; IC95%: 1,01-8,9; p=0,047) y la traqueotomía (OR=2,37; IC95%: 1,09-5,14; p=0,029) muestran asociación con la caída en el IS del EuroQoL 5D5L. El área bajo la curva ROC del modelo es del 67,3%, con un intervalo de confianza entre el 58% y el 76%. Se calibra el modelo mediante el test de Hosmer-Lemeshow:(χ2=0.468; p=0.792). Solamente el 1,2% de los pacientes mostraban una puntuación ≤ 24, claramente patológica, en el Minimental Test de Folstein.

Conclusiones

El delirio y la necesidad de traqueostomía se asocian a síndrome post-cuidados intensivos evaluado mediante EuroQol 5D5L.

Palabras clave:
Calidad de vida relacionada con la salud
EuroQol 5D5L
Síndrome post-cuidados intensivos
COVID 19

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