Composite Outcomes of Chronically Critically Ill Patients 4 Months After Hospital Discharge

Abstract

Background Data on likely postdischarge outcomes are important for decision making about chronically critically ill patients. It seems reasonable to categorize outcomes into “better” or overall desirable states and “worse” or generally undesirable states. Survival, being at home, and being cognitively intact are commonly identified as important to quality of life and thus may be combined to describe composite outcome states. Objective To categorize postdischarge outcome states of chronically critically ill patients and identify predictors of better and worse states. Methods Reanalysis of data from a trial of a disease management program for chronically critically ill patients. Two composite outcomes were created: (1) the “better” outcome: no cognitive impairment at 2 months after discharge and alive and at home at 4 months (ie, met all 3 criteria), and (2) the “worse” outcome: cognitive impairment 2 months after discharge, or death after discharge, or not living at home 4 months after discharge (ie, met at least 1 of these criteria). Results Of 218 patients not requiring ventilatory support at discharge, 111 (50.9%) had a better outcome. Of 159 patients who were cognitively intact at discharge, 111 (69.8%) had a better outcome. Of the 39 patients who required ventilatory support at discharge, only 1 (3%) achieved the better outcome. Of 98 patients who were cognitively impaired at discharge, only 29 (30%) had the better outcome. Conclusion Need for mechanical ventilatory support and persistent cognitive impairment at discharge were associated with worse outcomes 4 months after discharge.