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Association between days alive without life support/out of hospital and health-related quality of life

journal contribution
posted on 2023-07-21, 03:29 authored by Anders Granholm, Olav Lilleholt Schjorring, Aksel Karl Georg Jensen, Benjamin Skov Kaas-Hansen, Marie Warrer Munch, Thomas Lass Klitgaard, Elena Crescioli, Maj-Brit Norregaard Kjaer, Thomas Strom, Theis Lange, Anders Perner, Bodil Steen Rasmussen, Morten Hylander Moller
BACKGROUND: Trials in critically ill patients increasingly focus on days alive without life support (DAWOLS) or days alive out of hospital (DAOOH) and health-related quality of life (HRQoL). DAWOLS and DAOOH convey more information than mortality and are simpler and faster to collect than HRQoL. However, whether these outcomes are associated with HRQoL is uncertain. We thus aimed to assess the associations between DAWOLS and DAOOH and long-term HRQoL. METHODS: Secondary analysis of the COVID STEROID 2 trial including adults with COVID-19 and severe hypoxaemia and the Handling Oxygenation Targets in the Intensive Care Unit (HOT-ICU) trial including adult intensive care unit patients with acute hypoxaemic respiratory failure. Associations between DAWOLS and DAOOH at day 28 and 90 and long-term HRQoL (after 6 or 12 months) using the EuroQol 5-dimension 5-level survey (EQ VAS and EQ-5D-5L index values) were assessed using flexible models and evaluated using measures of fit and prediction adequacy in both datasets (comprising internal performance and external validation), non-parametric correlation coefficients and graphical presentations. RESULTS: We found no strong associations between DAWOLS or DAOOH and HRQoL in survivors at HRQoL-follow-up (615 and 1476 patients, respectively). There was substantial variability in outcomes, and predictions from the best fitted models were poor both internally and externally in the other trial dataset, which also showed inadequate calibration. Moderate associations were found when including non-survivors, although predictions remained uncertain and calibration inadequate. CONCLUSION: DAWOLS and DAOOH were poorly associated with HRQoL in adult survivors of severe or critical illness included in the COVID STEROID 2 and HOT-ICU trials.

History

Journal

ACTA ANAESTHESIOLOGICA SCANDINAVICA

Volume

67

Pagination

762-771

Location

England

ISSN

0001-5172

eISSN

1399-6576

Language

English

Publication classification

C1.1 Refereed article in a scholarly journal

Issue

6

Publisher

WILEY