Abstract Introduction Adult survivors of critical illness face several challenges during their recovery that include psychological distress and functional disabilities. One-third or more of intensive care unit (ICU) survivors experience post-traumatic stress disorder (PTSD), depression, and/or disabilities in daily function during the first year after hospital discharge. Few studies extend psychological and functional assessments beyond one year, and we are unaware of any beyond five years. Here, we present 12-year trajectories of psychological and functional outcomes after critical illness. Methods We performed an extended follow-up of a prospective, multicenter, observational study (BRAIN-ICU-1) that initially enrolled 821 critically ill adults admitted to a medical or surgical ICU for respiratory failure or shock. Assessments were performed at 3-month, 6-month, 12-month, 4-year, 6-year, and 12-year for eligible survivors. This included assessments of PTSD by Post-Traumatic Stress Disorder Checklist (PCL-17) with cutoff score of 36 or above, depression by Beck’s Depression Index-II (BDI-II) with cutoff score of 14 or above, and functional disabilities by the Functional Assessment Questionnaire (FAQ) with cutoff score of 9 or above. We used separate latent class modeling to identify distinct group-level longitudinal trajectories in each of the three outcomes, while accounting for the competing risk of death. Bayesian Information Criterion was used to select models with the best fit among models with 1 to 4 latent classes. Results For our primary outcome (PTSD), we assessed 416 patients at 3-months, 361 at 12-months, 218 at 4 years, 143 at 6 years, and 74 at 12 years. At 12-year follow-up, prevalence of psychological and functional outcomes in survivors eligible for assessment were: PTSD (16.2%), depression (21.6%), functional disability (16.9%). The latent class models with best fit suggested two group-level trajectories for PTSD (no PTSD; persistent PTSD; FIGURE 1), 2 groups for depression (no depression, persistent depression with moderate improvement), and 4 groups for functional disability (no disability, mild and worsening disability, severe and worsening disability, and moderate and improving disability). Conclusion In this extended cohort of a prospective observational study, we identified that PTSD, depression, and functional disabilities continue to affect survivors even after a decade. Among those affected with PTSD and depression over time, survivors tended to have persistent symptoms. Among those affected by functional disability over 12 years, some recovered, while others with mild and moderate disability worsened. Provision of psychological and functional support is still necessary in some ICU survivors over a decade after an index critical illness. This abstract is funded by: NIA
Rolfsen et al. (Fri,) studied this question.