Associations Between Physical, Cognitive, and Mental Health Domains of Post-Intensive Care Syndrome and Quality of Life: A Longitudinal Multicenter Cohort Study

OBJECTIVES: To explore associations between the physical, cognitive, and mental post-intensive care syndrome (PICS) health domains with changes in health-related quality of life (HRQoL) following ICU admission. DESIGN: A longitudinal prospective multicenter cohort study. SETTING/PATIENTS: Patients ( n = 4092) from seven Dutch ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At ICU admission, 3 and 12 months post-ICU, patients completed validated questionnaires regarding physical health problems, cognitive health problems, mental health problems, and HRQoL. Composite scores were created for the physical health domain (physical problems and fatigue) and mental health domain (anxiety, depression, and post-traumatic stress disorder). Adjusted multivariable linear regression analyses were performed, including covariables (e.g., patient characteristics, disease severity, pre-ICU HRQoL, etc.) to explore associations between the physical, cognitive, and mental health domains of PICS and changes in HRQoL at 3 and 12 months post-ICU. At 3 months ( n = 3368), physical health problems (β = –0.04 [95% CI, –0.06 to 0.02]; p < 0.001), cognitive health problems (β = –0.05 [95% CI, –0.09 to –0.02]; p < 0.001), and mental health problems (β = –0.08 [95% CI, –0.10 to –0.05]; p < 0.001) were negatively associated with changes in HRQoL. Also, at 12 months ( n = 2950), physical health problems (β = –0.06 [95% CI, –0.08 to –0.03]; p < 0.001), cognitive health problems (β = –0.04 [95% CI, –0.08 to –0.01]; p < 0.015), and mental health problems (β = –0.06 [95% CI, –0.08 to –0.03]; p < 0.001) were negatively associated with changes in HRQoL. CONCLUSIONS: PICS symptoms in the physical, cognitive, and mental domains are all negatively associated with changes in HRQoL at 3 and 12 months post-ICU. At 3 months, PICS symptoms in the mental domain seem to have the largest negative associations. At 12 months, the associations of PICS in the mental and physical domains are the same. This implies that daily ICU care and follow-up care should focus on preventing and mitigating health problems across all three PICS domains to prevent a decrease in HRQoL.