Critically Ill Medical Patient Outcomes after Discharge from Intensive Care – the prospective longitudinal ‘CIMPOD’ study of Malta’s national ICU survivors
Grech A.K., Abela C.J.
Mater Dei Hospital, Department of Anaesthesia & Intensive Care, Msida, Malta

Background and Goal of Study: Survival after critical illness invariably represents some degree of short term success, however the literature base for general & local intensive care unit (ICU) practice in particular exhibits lacunae for awareness of other post-ICU outcomes. Primary aims were to describe national prevalence of post-ICU mortality, urgent readmission, functional & emotional outcomes. Secondary goals included identification of potential predictors for risk stratification.

Materials and Methods: Consecutive adult ICU survivors were eligible over a 4 week recruitment period having spent >24 hours in our national 20 bed ICU facility. Age, gender & duration of ICU stay were recorded and retrospective acute physiology and chronic health evaluation (APACHE-II) illness severity scores calculated. 55 patients were followed up at intervals of 1 month, 3 months & 6 months after ICU discharge. Health related quality of life was evaluated via EuroQOL EQ-5D-3L and emotional outcomes via the Hospital Anxiety and Depression Scale.

Results and Discussion: Mortality was noted in 16.4% at 1 month after ICU discharge, reaching 20% at 6 months. A majority of patients (60%) exhibited no urgent readmission to state hospital services within 6 months. Mean overall health status perception on EQ-5D-3L visual analogue scale improved from 58.59 (±15.12) at 1 month to 68.07 (±16.18) at 6 months. Anxiety and depression scores showed positive correlation throughout, with 22.7% and 11.36% of participants ultimately demonstrating positive screening for anxiety & depression respectively. Regression models implicated age in prediction of health perception and gender in anxiety screening. Length of ICU stay was linked to post-ICU anxiety, depression & health status perception at 1 month. APACHE-II scores demonstrated significant potential as predictors of mortality and readmission across the 6 months post-ICU.

Conclusion(s): The preliminary CIMPOD post-ICU study represents one of the first of its kind in Maltese practice. Mortality & readmission may reflect a portion of less ill ICU admissions in the first instance due to lack of local high dependency beds, yet outcomes nevertheless show future research potential. Relationship modelling presents scope for risk stratification, with APACHE-II uniquely promising. Similar study protocols with greater numbers are suggested for future focus, with consideration of introduction of sickness scoring to Maltese practice recommended.

Critically Ill medical patient outcomes after discharge from intensive care – the prospective longitudinal ‘CIMPOD’ study of Malta’s national ICU survivors