Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population.
OBJECTIVE
To determine health-related quality of life in medical intensive care patients with multiple organ dysfunction.


METHODS
Prospective, observational study.


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


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


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.
Wehler
Markus
M
Departments of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany.
Geise
Arnim
A
Hadzionerovic
Dijana
D
Aljukic
Emgijada
E
Reulbach
Udo
U
Hahn
Eckhart Georg
EG
Strauss
Richard
R
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009102:Multiple Organ Failure; D011788:Quality of Life; D011795:Surveys and Questionnaires