Clinical study

Late functional outcome after critical illness in the Intensive Care Unit: Status and prediction

Pre-morbid functional status might influence the outcomes of patients undergoing critical illness and intensive care treatment. Additionally, the critical illness in itself can lead to aggravation in the long-term functional status. The exact relationship of these two factors to long-term outcomes are not thoroughly investigated, especially not in a Danish context.

The rationale of the studies in my Ph D project is to describe the particular long-term challenges that patients face after critical illness and intensive care treatment. This might contribute to future interventions aimed at reducing the decline in functional status for this group of patients. Moreover, the project will provide a description of patients that are prone to not benefitting from intensive care therapy or who will experience a pronounced decline in functional outcome after critical illness. The knowledge thus provided might be useful in assessing the patients who might benefit from intensive care therapy and to adjust the expectations to the result of the treatment. By identifying the patients in high risk for pronounced functional decline after intensive care therapy, it will also be possible to stratify patients to extended attention during and after admission, e.g. mobilization, exercise, occupational/cognitive training and rehabilitation.

Some of the studies are nested in the AID-ICU trial.

The studies of my thesis:

1. One-year follow-up of participants in the AID-ICU trial included on the sites Aalborg, Køge and Rigshospitalet. Outcomes are Lawton-Brody IADL, Bathels 20-ADL, Clinical Frailty Scale og grip strength at one year after randomization in the trial. The study is a nestet RCT in the AID-ICU trial. The results will be differences between the two interventional arms, placebo and haloperidol. Outcomes will be adjusted for pre-admission status, IQCODE, Barthel-20 and Clinical Frailty.
2. Association of pre-morbid status to 90-day and one-year mortality. Explanatory variables are pre-admission IQCODE, Barthels 20-ADL, Comorbidity-Polyphamacy Score og Clinical Frailty Scale. The study is performed on the same population af in study 1, but is analyzed as a observational cohort.
3. Pre-admission frailty og multi morbidity as a predictor for mortality in a mixed-ICU population.  The study is performed on a one-year observational cohort of patients admitted to the ICU at Zealand University Hosptial Køge. Predictive variables are pre-admission Clinical Frailty Scale and Comorbidity-Polypharmacy Score. Association and ROC for pre-admission status, time on ventilator and 30 day mortality are investigated.
4. Systematisk review og meta-analysis of pre-admission health status and the importance for outcome for patients admitted to the ICU.