Quality-adjusted Survival in the First Year after the Acute Respiratory Distress Syndrome

Abstract

There is little information on long-term outcome after acute respiratory distress syndrome (ARDS). We measured quality-adjusted survival in the first year after ARDS in a prospective cohort (n = 200). All patients met traditional criteria for ARDS. Patients with sepsis and acute nonpulmonary organ dysfunction at presentation were excluded. The cohort was healthy before onset of ARDS as evidenced by high functional status (mean Karnofsky Performance Status index: 82.2/100 where >/= 80 = able to perform normal activities independently) and minimal comorbid illness (mean Charlson-Deyo comorbidity score: 0.32/17 where 0 = absence of chronic illness). We determined quality-adjusted life-years (QALYs) using the Quality of Well-being (QWB) scale (0 to 1 scale where 1 = optimal well-being), measured at 6 and 12 mo. Survival was 69.5 +/- 5.0% at 1 month, fell to 55.7 +/- 3.7% at 6 mo, and did not change at 12 mo, yielding a survival of 59 life-years in the first year per 100 patients with ARDS. QWB was low at 6 and 12 mo (0.59 +/- 0.015 and 0.60 +/- 0.015), yielding a quality-adjusted survival of 36 QALYs per 100 patients (sensitivity range: 21 to 46 QALYs). We conclude that ARDS developing in previously healthy patients is associated with poor quality-adjusted survival. These data are important for cost-effectiveness analyses and long-term care.

The Effect of Primary Graft Dysfunction on Survival after Lung Transplantation

“…However, in a single center, we have previously reported that survivors of PGD have worse pulmonary function and functional exercise capacity at 1 year (1, 5). Furthermore, nontransplant subjects who survive acute respiratory distress syndrome or sep- sis have greater mortality after hospital discharge (11,16,17), and survivors of acute respiratory distress syndrome have an increased risk of prolonged disability because of neuropathy, myopathy, malnutrition, and deconditioning (12). Thus, our findings may be attributable to the lingering effects after prolonged critical illness and the inability to withstand another illness.…”

“…In one study, it was suggested that severe ischemia-reperfusion injury increases the risk of chronic rejection and long-term mortality (9); however, others have found no such relationship (3). Furthermore, survivors of severe acute lung injury from a variety of other causes have increased mortality and impaired quality of life extending far beyond the initial hospitalization (10)(11)(12). Therefore, survivors of PGD could possibly have an increased risk of long-term mortality because of either chronic rejection or the after-effects of extended critical illness.…”

The status of intensive care medicine research and a future agenda for very old patients in the ICU

“…Survivors of critical illness have been found to suffer from long-term sequelae, including increased long-term mortality [25], poor quality-adjusted survival [26], cognitive impairment and functional disability [27,28]. VOPs are not exempt from such adverse events, which often are perceived to occur beyond the scope of intensive care.…”

A Step towards Medical Ethics Modeling

“…decreasing, the probability of mortality is considerably high and moreover this procedure results in a low quality-adjusted survival in the first year after ARDS [8,13] The continuous logic program for the extension of the predicate survival-rate: { ¬survival-rate(X, Y) ← not survival-rate(X, Y ) and not exception(survival-rate(X, Y)), exception(survival-rate(X, Y)) ← survival-rate(X, unknown-survival-rate), survival-rate(X, Y) ← ards(X) and pao2(X, low) and evaluate(X,Y), exception(survival-rate(gb, 0.5)), ? ((exception(survival-rate(X,Y)) or exception(survival-rate(X,Z))) and ¬(exception(survivalrate(X,Y)) and exception(survival-rate(X, Z))) /This invariant states that the exceptions to the predicate survival-rate follow an exclusive or/ }agsurvival-rate…”