Multimorbidity and its relationship with long-term outcomes following critical care discharge: a prospective cohort study

McPeake, J. , Quasim, T. , Henderson, P., Leyland, A. H. , Lone, N. I., Walters, M. , Iwashyna, T. J. and Shaw, M. (2021) Multimorbidity and its relationship with long-term outcomes following critical care discharge: a prospective cohort study. Chest, (doi: 10.1016/j.chest.2021.05.069) (PMID:34153342) (In Press)

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Abstract

Background: Survivors of critical illness have poor long-term outcomes with subsequent increases in healthcare utilisation. Less is known about the interplay between multimorbidity and long-term outcomes. Research Question: How do baseline patient demographics impact mortality and healthcare utilisation in the year following discharge from critical care? Study design and methods: Using data from a prospectively collected cohort, we employed propensity score matching to assess differences in outcomes between patients with a critical care encounter and patients admitted to the hospital without critical care. Long-term mortality was examined via nationally linked data as was hospital resource use in the year following hospital discharge. The cause of death was also examined. Results: This analysis included 3112 participants. There was no difference in long-term mortality between the critical care and hospital cohorts (adjusted HR: 1.09 (95% CI: 0.90-1.32), p=0.39). Pre-hospitalisation emotional health issues such as a clinical diagnosis of depression, were associated with increased long-term mortality (HR:1.49 (95% CI: 1.14-1.96), p<0.004). Healthcare utilisation was different between the two cohorts in the year following discharge with the critical care cohort experiencing a 29% increased risk of hospital readmission (OR 1.29 (95% CI:1.11-1.50), p=0.001). Interpretation: This national cohort study has demonstrated increased resource use for critical care survivors in the year following discharge but fails to replicate past findings of increased longer-term mortality. Multimorbidity, lifestyle factors and socio-economic status appear influence long term outcomes and should be the focus of future research.

Item Type:Articles
Status:In Press
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quasim, Professor Tara and Leyland, Professor Alastair and Henderson, Dr Philip and Shaw, Dr Martin and McPeake, Dr Jo and Walters, Professor Matthew
Authors: McPeake, J., Quasim, T., Henderson, P., Leyland, A. H., Lone, N. I., Walters, M., Iwashyna, T. J., and Shaw, M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Chest
Publisher:Elsevier
ISSN:0012-3692
ISSN (Online):1931-3543
Published Online:18 June 2021
Copyright Holders:Copyright © 2021 Elsevier Inc
First Published:First published in Chest 2021
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
307748Improving health and social care integration delivery in the acute care environmentJoanne McPeakeUniversity of Cambridge (HEI-CAMB)RG88620HW - MRC/CSO Social and Public Health Sciences Unit
Chief Scientist Office (CSO)SPHSU13
Medical Research Council (MRC)MC_UU_00022/2
Chief Scientist Office (CSO)SPHSU17