To describe the frequency of co-occurring newly acquired cognitive impairment, disability in activities of daily living (ADLs), and depression among survivors of a critical illness and to evaluate predictors of being Post-Intensive Care Syndrome (PICS)-free (i.e., no PICS problems).
Patients with respiratory failure or shock, excluding those with preexisting cognitive impairment or disability in ADLs.
At 3 and 12 months after hospital discharge we assessed patients for cognitive impairment, disability, and depression. We categorized patients into eight groups reflecting combinations of cognitive, disability, and mental health problems. Using multivariable logistic regression, we modeled the association between age, education, frailty, durations of mechanical ventilation, delirium, and severe sepsis with the odds of being PICS-free.
We analyzed 406 patients with a median age of 61 years and an APACHE II of 23. At 3 and 12 months, one or more PICS problems were present in 64% and 56%, respectively. Nevertheless, co-occurring PICS problems (i.e., in two or more domains) were present in 25% at 3 months and 21% at 12 months. PICS problems in all three domains were present in only 6% at 3 months and 4% at 12 months. More years of education was associated with greater odds of being PICS-free (P<0.001 at 3 and 12 months). More severe frailty was associated with lower odds of being PICS-free (P=0.005 at 3 months and P=0.048 at 12 months).
In this multicenter cohort study, one or more PICS problems were present in the majority of survivors, but co-occurring problems were present in only 1 out of 4. Education was protective from PICS and frailty predictive of the development of PICS. Future studies are needed to understand better the heterogeneous subtypes of PICS and to identify modifiable risk factors.