title: Physical declines occurring after hospital discharge in ARDS survivors: a 5-year longitudinal study.
abstract: OBJECTIVE
  Survivors of acute respiratory distress syndrome (ARDS) are at high risk for new or ongoing physical declines after hospital discharge. The objective of our study was to evaluate the epidemiology of physical declines over 5-year follow-up and identify patients at risk for decline.
  
  
  METHODS
  This multi-site prospective cohort study evaluated ARDS survivors who completed a physical status assessment at 3 or 6 months post-discharge. Three measures were evaluated: muscle strength (Medical Resource Council sumscore); exercise capacity [6-min walk test (6MWT)]; physical functioning [36-Item Short Form Health Survey (SF-36 survey)]. Patients were defined as "declined" if a comparison of their current and prior score showed a decrease that was greater than the Reliable Change Index-or if the patient died. Risk factors [pre-ARDS baseline status, intensive care unit (ICU) illness severity, and other intensive care variables] were evaluated using longitudinal, generalized linear regression models for each measure.
  
  
  RESULTS
  During the follow-up of 193 ARDS survivors (55 % male; median age 49 years), 166 (86 %) experienced decline in ≥1 physical measure (including death) and 133 (69 %) experienced a physical decline (excluding death). For all measures, age was a significant risk factor [odds ratios (OR) 1.34-1.69 per decade; p < 0.001]. Pre-ARDS comorbidity (Charlson Index) was independently associated with declines in strength and exercise capacity (OR 1.10 and 1.18, respectively; p < 0.02), and organ failure [maximum daily Sequential Organ Failure Assessment (SOFA) score in ICU] was associated with declines in strength (OR 1.06 per 1 point of SOFA score; p = 0.02).
  
  
  CONCLUSIONS
  Over the follow-up period, the majority of ARDS survivors experienced a physical decline, with older age and pre-ICU comorbidity being important risk factors for this decline.
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.|Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Pfoh
authors.affiliation: Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Amy W
authors.initials: AW
authors.lastname: Wozniak
authors.affiliation: Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.|Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD, USA.
authors.forename: Victor D
authors.initials: VD
authors.lastname: Dinglas
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Mendez-Tellez
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Shanholtz
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Ciesla
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.affiliation: Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dale.needham@jhmi.edu.|Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD, USA. dale.needham@jhmi.edu.|Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dale.needham@jhmi.edu.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D000328:Adult; D000367:Age Factors; D018450:Disease Progression; D017079:Exercise Tolerance; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D063305:Organ Dysfunction Scores; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D011788:Quality of Life; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: Acute respiratory distress syndrome; Intensive care unit; Physical function; Recovery of function