Background

The post intensive care syndrome (PICS) gathers various disabilities, associated with a substantial healthcare use. However, patients’ comorbidities and active medical conditions prior to intensive care unit (ICU) admission may partly drive healthcare use after ICU discharge. To better understand retative contribution of critical illness and PICS—compared to pre-existing comorbidities—as potential determinant of post-critical illness healthcare use, we conducted a population-based evaluation of patients’ healthcare use trajectories.

Results

Using discharge databases in a 2.5-million-people region in France, we retrieved, over 3 years, all adult patients admitted in ICU for septic shock or acute respiratory distress syndrome (ARDS), intubated at least 5 days and discharged alive from hospital: 882 patients were included. Median duration of mechanical ventilation was 11 days (interquartile ranges [IQR] 8;20), mean SAPS2 was 49, and median hospital length of stay was 42 days (IQR 29;64). Healthcare use (days spent in healthcare facilities) was analyzed 2 years before and 2 years after ICU admission. Prior to ICU admission, we observed, at the scale of the whole study population, a progressive increase in healthcare use. Healthcare trajectories were then explored at individual level, and patients were assembled according to their individual pre-ICU healthcare use trajectory by clusterization with the K-Means method. Interestingly, this revealed diverse trajectories, identifying patients with elevated and increasing healthcare use (n = 126), and two main groups with low (n = 476) or no (n = 251) pre-ICU healthcare use. In ICU, however, SAPS2, duration of mechanical ventilation and length of stay were not different across the groups. Analysis of post-ICU healthcare trajectories for each group revealed that patients with low or no pre-ICU healthcare (which represented 83% of the population) switched to a persistent and elevated healthcare use during the 2 years post-ICU.

Conclusion

For 83% of ARDS/septic shock survivors, critical illness appears to have a pivotal role in healthcare trajectories, with a switch from a low and stable healthcare use prior to ICU to a sustained higher healthcare recourse 2 years after ICU discharge. This underpins the hypothesis of long-term critical illness and PICS-related quantifiable consequences in healthcare use, measurable at a population level.

中文翻译：

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重大疾病前后的医疗保健轨迹：基于人群的不同患者群体的见解

背景

重症监护后综合症（PICS）聚集了各种残疾，与大量医疗保健相关。但是，重症监护病房（ICU）入院前患者的合并症和活跃的医疗状况可能会部分驱使ICU出院后的医疗保健用途。为了更好地了解重症疾病和PICS（与先前合并症相比）对重症疾病后医疗保健使用的潜在决定因素的贡献，我们对患者的医疗保健使用轨迹进行了基于人群的评估。

结果

使用法国250万人口地区的出院数据库，我们检索了3年多来所有因感染性休克或急性呼吸窘迫综合征（ARDS）在ICU住院的成年患者，进行了至少5天的插管并活着出院：包括882名患者。机械通气的中位时间为11天（四分位间距[IQR] 8; 20），平均SAPS2为49，中位住院时间为42天（IQR 29; 64）。在ICU入院前2年和入院后2年对医疗保健使用情况（在医疗机构中花费的天数）进行了分析。在入住ICU之前，我们观察到整个研究人群的医疗保健使用量逐渐增加。然后在个人层面上探索医疗保健的轨迹，然后使用K-Means方法进行聚类，根据患者在ICU之前的医疗使用轨迹将其组装起来。有趣的是，这揭示了不同的轨迹，确定了医疗保健使用量不断增加的患者（n  = 126），以及两个主要组， ICU之前的医疗保健使用率较低（n  = 476）或没有（n = 251）。然而，在ICU中，SAPS2的机械通气持续时间和住院时间在两组之间没有差异。对每组ICU术后医疗状况的分析显示，ICU发生后两年内，ICU发生前医疗保健水平较低或没有的患者（占人口的83％）转而使用持续性和高水平的医疗保健服务。

结论

对于83％的ARDS /败血性休克幸存者，危重病似乎在医疗保健轨迹中起着关键作用，从ICU出院前低而稳定的医疗保健使用转变为ICU出院后2年持续提高医疗保健资源。这支持了长期严重疾病和与PICS相关的可量化后果（在人群水平上可测量）的假设。