Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 4, 2016; 5(4): 219-227
Published online Nov 4, 2016. doi: 10.5492/wjccm.v5.i4.219
Determination of functional prognosis in hospitalized patients following an intensive care admission
Natália A Ferreira, Agnaldo José Lopes, Arthur S Ferreira, George Ntoumenopoulos, Jerffesson Dias, Fernando S Guimaraes
Natália A Ferreira, Agnaldo José Lopes, Arthur S Ferreira, Fernando S Guimaraes, Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Centre, Rio de Janeiro 21041-020, Brazil
Natália A Ferreira, Jerffesson Dias, Physical Therapy Department, Barra D’Or Hospital, Rio de Janeiro 22775-002, Brazil
Agnaldo José Lopes, Post-Graduation Program in Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro 20550-900, Brazil
George Ntoumenopoulos, George Ntoumenopoulos, Graduate School of Health Sciences, University of Technology Sydney, Sydney NSW 2007, Australia
Fernando S Guimaraes, Physical Therapy Department, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
Author contributions: Ferreira NA, Lopes AJ and Guimaraes FS designed the research and wrote the paper; Ferreira AS and Dias J performed the research and contributed for the project; Ferreira NA analyzed the data and reviewed the final version of the paper; Ntoumenopoulos G wrote and reviewed the final version of the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Augusto Motta University Centre.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data obtained from the hospital database.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fernando S Guimaraes, PT, PhD, Associate Professor, Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Centre, Praça das Nações, 34, Bonsucesso, Rio de Janeiro 21041-010, Brazil. fguimaraes_pg@yahoo.com.br
Telephone: +55-21-991243760 Fax: +55-21-24385178
Received: March 7, 2016
Peer-review started: March 9, 2016
First decision: May 19, 2016
Revised: July 1, 2016
Accepted: August 17, 2016
Article in press: August 18, 2016
Published online: November 4, 2016
Abstract
AIM

To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission.

METHODS

Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality (KATZ Index of Independence in Activities of Daily Living) and muscle strength (MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit (ICU), in the Ward (WARD) and the total time of hospital stay (TOT).

RESULTS

Considering the functional outcome (ΔKATZ), the variables that significantly contributed to the model (P < 0.05) were the KATZ and MRC on admission, age, sepsis (no), and total length of stay (TLS). Regarding the muscle strength outcome model (ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex (female). The variable age (AUC = 0.664) discriminated the ΔKATZICU. The variables age (AUC = 0.712), KATZ in ICU (AUC = 0.590) and on ward admission (AUC = 0.746), and MRC on ward admission (AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission (AUC = 0.621) and TLS (AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII (AUC = 0.661) and MRC on ICU admission (AUC = 0.653) were discriminative. MRC on ICU (AUC = 0.681) and ward admission (AUC = 0.553) were discriminative for ΔMRCWARD. TLS (AUC = 0.649) and MRC on ward admission (AUC = 0.696) discriminative for the ΔMRCTOT.

CONCLUSION

Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.

Keywords: Muscle strength, Intensive care units, Activities of daily living, Rehabilitation, Early mobilization, Post-intensive care unit syndrome

Core tip: In spite of the advances in critical care, functional deficits are commonly observed during and after the hospitalization period. This retrospective study aimed to investigate the factors associated with the functional progress in a cohort of patients that underwent a mobilization protocol, from the intensive care unit (ICU) to the hospital discharge. As functional ability, muscle strength, low illness severity score at ICU and ward admission, absence of sepsis and stroke, longer total length of stay, male gender and younger age were predictors of favourable patients’ functional progress, these variables should be taken in consideration when planning rehabilitative strategies for hospitalized patients following an intensive care admission.