Association of Days Alive and at Home at Day 90 After Intensive Care Unit Admission With Long-term Survival and Functional Status Among Mechanically Ventilated Patients

Taran, S; Coiffard, B; Huszti, E; Li, Q; Chu, L; Thomas, C; Burns, S; Robles, P; Herridge, MS; Goligher, EC

doi:10.1001/jamanetworkopen.2023.3265

Association of Days Alive and at Home at Day 90 After Intensive Care Unit Admission With Long-term Survival and Functional Status Among Mechanically Ventilated Patients

JAMA Netw OpenPublished 1 Mar 2023Secondary analysis of the RECOVER prospective cohort study

Primary result · Mortality at 1 year after ICU admission (survivors to day 90)ResultAHR for death 0.18 95% CI 0.07–0.43

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Authors' conclusion

In this study, lower DAAH90 was associated with greater long-term mortality risk and worse functional outcomes among patients who survived to day 90.

Study context

Population: Patients aged ≥16 years with invasive mechanical ventilation for ≥7 days, 10 intensive care units (ICUs) in Canada, 2007–2014292 in follow-up cohort
Participants: 463 patients

Comparison: DAAH90 tertile 1 vs tertile 3
Primary endpoint: Functional outcomes (Functional Independence Measure (FIM), 6MWT, Medical Research Council (MRC), SF-36 PCS) and 1-year mortality
Follow-up: 3, 6, and 12 months

Methodological detailsmulticentre (10 ICUs)

Multicentre (10 ICUs)

Primary result

As reported in the abstract

Mortality at 1 year after ICU admission (survivors to day 90) · 1 year

AHR for death

0.18

95% CI 0.07–0.43

P < 0.001

Tertile 1 vs Tertile 3

aHR for death 0.18 (95% CI 0.07–0.43); P < 0.001

Further findings

Median

Outcome	Tertile 1	Tertile 3	Estimate (95% CI)	P value
FIM score · 3 months	76 (IQR 46.2–101)	121 (IQR 112–124.2)		P = 0.04
6MWT · 3 months	98 (IQR 0–239)	402 (IQR 300–494)		P < 0.001
MRC muscle strength · 3 months	48 (IQR 32–54)	58 (IQR 51–60)		P < 0.001
SF-36 PCS · 3 months	30 (IQR 22–38)	37 (IQR 31–47)		P = 0.001
FIM score (survivors to 12 months)			22.4 (14.8–30.0)	P < 0.001
Ventilator-free days · day 28			6.0 (−2.2 to 14.1)	P = 0.15
ICU-free days · day 28			5.9 (−2.1 to 13.8)	P = 0.15

Original publication

Association of Days Alive and at Home at Day 90 After Intensive Care Unit Admission With Long-term Survival and Functional Status Among Mechanically Ventilated Patients. JAMA Netw Open. Published 1 March 2023. doi:10.1001/jamanetworkopen.2023.3265

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