Long-Term Outcomes of Persistent Critical Illness

Rationale: The term "persistent critical illness" (PerCI; defined as an ICU stay of ⩾10 or more days) refers to the condition of a growing group of patients in the intensive care unit (ICU) whose critical illness persists into chronicity. These patients account for a disproportionate amount of resources, yet long-term functional outcomes are unknown. Objectives: We sought to compare death or new disability at 6 months in ICU patients with and without Methods: We performed a secondary analysis of a multicenter, prospective cohort study that was conducted in six metropolitan ICUs. Participants were adults admitted to an ICU who received more than 24 hours of mechanical ventilation. Patients who died before Day 10 were excluded from the control group. The primary outcome was death or new disability at 6 months, adjusted for various covariates, with new disability defined as a ⩾10% increase from baseline as measured with the World Health Organization Disability Assessment Schedule 2.0. We included various secondary outcomes (e.g., quality of life, cognition, mental health, return to work) to assess recovery holistically at 3 and 6 months. A significance level of 0.01 was used to compensate for multiplicity. Results: Of 888 total enrolled patients, 799 survived to Day 10. Of these, the primary outcome was available in 670 (84%) patients, 188 with PerCI and 482 in the control group. The primary outcome was present in 124/171 (72.5%) of patients with PerCI and 246/457 (53.8%) of the control group: adjusted risk difference, 10.70; 95% confidence interval (CI) = 0.47-20.90; P = 0.040. At 6 months, the mortality rate was higher in the PerCI group compared with the control group: 76/252 (30.2%) and 57/547 (10.4%), respectively (adjusted risk difference, 15.04; 95% CI = 9.65-20.39; P < 0.001). In survivors, 48/95 (50.5%) of the PerCI group developed a new disability, compared with 100/311 (32.2%) in the control group (adjusted risk difference, 9.98; 95% CI = -0.27, 20.20; P = 0.056). Assessment of secondary outcomes showed several differences at 3 months that were reduced by 6 months, and residual differences were largely related to physical function. Conclusions: Patients with PerCI had a similar incidence of death or new disability at 6 months. However, an assessment of secondary outcomes showed significant recovery in survivors of PerCI between 3 and 6 months.