title: Functional Status in ICU Survivors and Out of Hospital Outcomes: A Cohort Study.
abstract: OBJECTIVE
  Functional status at hospital discharge may be a risk factor for adverse events among survivors of critical illness. We sought to examine the association between functional status at hospital discharge in survivors of critical care and risk of 90-day all-cause mortality after hospital discharge.
  
  
  METHODS
  Single-center retrospective cohort study.
  
  
  METHODS
  Academic Medical Center.
  
  
  METHODS
  Ten thousand three hundred forty-three adults who received critical care from 1997 to 2011 and survived hospitalization.
  
  
  METHODS
  None.
  
  
  RESULTS
  The exposure of interest was functional status determined at hospital discharge by a licensed physical therapist and rated based on qualitative categories adapted from the Functional Independence Measure. The main outcome was 90-day post hospital discharge all-cause mortality. A categorical risk-prediction score was derived and validated based on a logistic regression model of the function grades for each assessment. In an adjusted logistic regression model, the lowest quartile of functional status at hospital discharge was associated with an increased odds of 90-day postdischarge mortality compared with patients with independent functional status (odds ratio, 7.63 [95% CI, 3.83-15.22; p < 0.001]). In patients who had at least 7 days of physical therapy treatment prior to hospital discharge (n = 2,293), the adjusted odds of 90-day postdischarge mortality in patients with marked improvement in functional status at discharge was 64% less than patients with no change in functional status (odds ratio, 0.36 [95% CI, 0.24-0.53]; p < 0.001).
  
  
  CONCLUSIONS
  Lower functional status at hospital discharge in survivors of critical illness is associated with increased postdischarge mortality. Furthermore, patients whose functional status improves before discharge have decreased odds of postdischarge mortality.
authors.affiliation: 1Department of Rehabilitation, Brigham and Women's Hospital, Boston, MA. 2Department of Medicine, Brigham and Women's Hospital, Boston, MA. 3Department of Nutrition, Brigham and Women's Hospital, Boston, MA. 4Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA. 5Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Austria. 6The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Rydingsward
authors.forename: Clare M
authors.initials: CM
authors.lastname: Horkan
authors.forename: Kris M
authors.initials: KM
authors.lastname: Mogensen
authors.forename: Sadeq A
authors.initials: SA
authors.lastname: Quraishi
authors.forename: Karin
authors.initials: K
authors.lastname: Amrein
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Christopher
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016638:Critical Illness; D005260:Female; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D017741:Survivors; D013997:Time Factors