title: One-year survival and resource use after critical illness: impact of organ failure and residual organ dysfunction in a cohort study in Brazil.
abstract: BACKGROUND
  In this study, we evaluated the impacts of organ failure and residual dysfunction on 1-year survival and health care resource use using Intensive Care Unit (ICU) discharge as the starting point.
  
  
  METHODS
  We conducted a historical cohort study, including all adult patients discharged alive after at least 72 h of ICU stay in a tertiary teaching hospital in Brazil. The starting point of follow-up was ICU discharge. Organ failure was defined as a value of 3 or 4 in its corresponding component of the Sequential Organ Failure Assessment score, and residual organ dysfunction was defined as a score of 1 or 2. We fit a multivariate flexible Cox model to predict 1-year survival.
  
  
  RESULTS
  We analyzed 690 patients. Mortality at 1 year after discharge was 27%. Using multivariate modeling, age, chronic obstructive pulmonary disease, cancer, organ dysfunctions and albumin at ICU discharge were the main determinants of 1-year survival. Age and organ failure were non-linearly associated with survival, and the impact of organ failure diminished over time. We conducted a subset analysis with 561 patients (81%) discharged without organ failure within the previous 24 h of discharge, and the number of residual organs in dysfunction remained strongly associated with reduced 1-year survival. The use of health care resources among hospital survivors was substantial within 1 year: 40% of the patients were rehospitalized, 52% visited the emergency department, 90% were seen at the outpatient clinic, 14% attended rehabilitation outpatient services, 11% were followed by the psychological or psychiatric service and 7% used the day hospital facility. Use of health care resources up to 30 days after hospital discharge was associated with the number of organs in dysfunction at ICU discharge.
  
  
  CONCLUSIONS
  Organ failure was an important determinant of 1-year outcome of critically ill survivors. Nevertheless, the impact of organ failure tended to diminish over time. Resource use after critical illness was elevated among ICU survivors, and a targeted action is needed to deliver appropriate care and to reduce the late critical illness burden.
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 5th floor, Room 5023, São Paulo, 05403-010, Brazil. otavioranzani@yahoo.com.br.
authors.forename: Otavio T
authors.initials: OT
authors.lastname: Ranzani
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 5th floor, Room 5023, São Paulo, 05403-010, Brazil. fgzampieri@gmail.com.
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Zampieri
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 5th floor, Room 5023, São Paulo, 05403-010, Brazil. brunobesen@yahoo.com.br.
authors.forename: Bruno A M P
authors.initials: BA
authors.lastname: Besen
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 5th floor, Room 5023, São Paulo, 05403-010, Brazil. lucianoazevedo@uol.com.br.|Research and Education Institute, Hospital Sirio-Libanes, São Paulo, Brazil. lucianoazevedo@uol.com.br.
authors.forename: Luciano C P
authors.initials: LC
authors.lastname: Azevedo
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, 5th floor, Room 5023, São Paulo, 05403-010, Brazil. marcelo10pk@gmail.com.|Research and Education Institute, Hospital Sirio-Libanes, São Paulo, Brazil. marcelo10pk@gmail.com.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
mesh_terms: D000069537:Adult Day Care Centers / Q000706:statistics & numerical data; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology*; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D063305:Organ Dysfunction Scores; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012709:Serum Albumin; D017741:Survivors
chemical_list: D012709:Serum Albumin