Patient or family perceived deterioration in functional status and outcome after Intensive Care admission: a retrospective cohort analysis of routinely collected data

Objective: To explore the association of patient or family reported
functional deterioration (defined by a single question) in the preceding
year, with mortality outcome for those admitted to the Intensive Care Unit
(ICU).   Design: Retrospective observational analysis of a
routinely collected data source.   Participants: Patients that
were admitted to the ICU at Northwick Park Hospital, London North West
University Healthcare NHS Trust between 1/10/2017 to 15/6/2019 were
included. Patients were excluded if they had a prior ICU admission during
the existing hospital episode or if information on functional
deterioration could not be retrieved from either the patient or their
advocate.   Primary Outcomes: Mortality at the point of hospital
discharge and 1 year following admission to the ICU.   Results:
Of the 1006 patients who were admitted to the ICU during the study period,
information on functional deterioration was available for 621 patients who
were included in the analysis. From these, 251 (40.4%) patients had
patient or family reported functional deterioration in the preceding year,
whilst 370 (59.6%) patients had a perceived stable functional baseline.
Comparing the two groups, mortality was significantly higher in those who
had functionally deteriorated compared to those with stable baseline
function, at the point of hospital discharge (45.4% versus 25.9%;
P<0.0001) and at 1 year (59.4% versus 33.0%;
P<0.0001).    Conclusion: Patient or family
reported functional deterioration was significantly associated with higher
mortality at the point of hospital discharge and at 1 year. The concept of
functional deterioration in the lead up to ICU admission warrants further
exploration.