Cooccurrence of Problems in the PostIntensive Care Syndrome among 406 Survivors of Critical Illness

Purpose Post-Intensive Care Syndrome (PICS) is characterized by new or worse cognitive impairment, disability, and mental health impairment after critical illness. The frequency of co-occurring problems in PICS, along with factors associated with being PICS-free, is unclear. Methods We included patients with respiratory failure or shock, excluding those with preexisting cognitive impairment or disability in activities of daily living. At 3 and 12 months after hospital discharge, we assessed patients for cognitive impairment, disabilities in activities of daily living, and depression. We categorized patients into eight groups reflecting combinations of cognitive, disability, and mental health problems. We modeled the association between age, education, frailty, durations of mechanical ventilation, delirium, and severe sepsis with the odds of being PICS-free using multivariable regression. Results We analyzed 406 patients who were a median age of 61 years old with an APACHE II of 23. PICS was present in 64% and 56% of patients at 3 and 12 months, respectively. Co-occurring problems in all 3 domains were present in 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). Frailty was associated with lower odds of being PICS-free at 3 months (P=0.005). Conclusions PICS was present in the majority of survivors of critical illness. Co-occurring problems in all 3 PICS domains was rare. Greater years of education were protective from PICS. Future studies are needed to understand better the heterogeneous subtypes of PICS and to identify modifiable risk factors for this syndrome.