Subjective Ratings of Mental and Physical Health Correlate With EQ-5D-5L Index Values in Survivors of Critical Illness: A Construct Validity Study*

Abstract

Survivors of critical illness commonly show impaired healthrelated quality of life (HrQoL). We investigated if HrQoL can be approximated by brief, easily applicable items to be used in primary care.DESIGN: Secondary analysis of data from the multicenter, cluster-randomized controlled Enhanced Recovery after Intensive Care trial (ClinicalTrials.gov: NCT03671447) and construct validity study. SETTING:Ten participating clusters of ICUs in the metropolitan area of Berlin, Germany. PATIENTS:Eight hundred fifty ICU survivors enrolled in a mixed, medical or surgical ICU when they had an expected ICU length of stay of at least 24 hours, were at least 18 years old, and had statutory health insurance coverage. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Patients received follow-ups scheduled 3 and 6 months after ICU discharge. HrQoL was assessed with the EuroQol 5-Dimension 5-Level (EQ-5D-5L), and patients were asked to rate their current mental and physical health state from 0 (worst) to 10 (best). We fitted prediction models for the EQ-5D-5L index value using these two items and additional covariates, applying stepwise regression and adaptive lasso. Subjective mental health (Spearman: 0.59) and subjective physical health (Spearman: 0.68) correlated with EQ-5D-5L index values and were better predictors of EQ-5D-5L index values in the two-item regression (normalized root mean squared error [nRMSE] 0.164; normalized mean absolute error [nMAE] 0.118; R 2 adj 0.43) than the EQ-5D Visual Analog Scale (nRMSE 0.175; nMAE 0.124; R 2 adj 0.35). Stepwise regression with additional covariates further increased prediction performance (nRMSE 0.133; nMAE 0.1; R 2 adj 0.51). CONCLUSIONS:Asking patients to rate their subjective mental and physical health can be an easily applicable tool for a first impression of the HrQoL in primary care settings. KEY WORDS: critical care; postintensive care unit care; postintensive care syndrome; primary care; quality of life T he demand for intensive care medicine has been increasing (1, 2) and is forecasted to further grow in the future (3). At the same time, ICU mortality rates are steadily declining (4). Various studies have shown that the growing cohort of survivors of critical illness commonly faces longterm impairments of their health-related quality of life (HrQoL) (5-10). This might be attributable to long-term sequelae of their mental health, cognition,

Determinants of Subjective Mental and Functional Health of Critical Illness Survivors: Comparing Pre-ICU and Post-ICU Status

“…Past studies have highlighted reductions in HrQoL following critical illness (15,16,18,36), commonly assessed using SF-36 and EQ-5D (15,16,18,36). EQ-5D index values were shown to correspond well to the subjective mental and functional health ratings used in this study (25). Previous studies either anchored their HrQoL estimates with a reference non-ICU population or asked participants to retrospectively report their HrQoL before ICU admission (15).…”

Surviving Critical Illness: Alive and Kicking or Alive and Agonizing?*

“…Poor scores may prompt primary care physicians to perform more in-depth assessments or refer ICU survivors for more specialized care, so that mental and physical health problems might be promptly diagnosed and treated. The parsimonious tests in the study by Paul et al (7) could also be communicated as follow-up items in discharge summaries or other communications to primary care physicians; these tests could even be performed at the time of hospital discharge. Earlier diagnosis and management of mental and physical health problems such as depression, insomnia, fatigue, or pain has great potential for improving post-ICU HRQoL.…”

“…Featured in this issue is a secondary analysis from the multicenter, stepped-wedge cluster-randomized controlled Enhanced Recovery after Intensive Care trial (6). Paul et al (7) sought to assess how well simple subjective mental and physical health ratings might predict index values of the previously validated HRQoL instrument, the EuroQol-5D-Five-Level (EQ-5D-5L). Comparisons were also made with the EuroQol-5D (EQ-5D) Visual Analog Scale (VAS).…”

“…Although limited slightly by the retrospective nature of the study design, imperfect (65%) follow-up, and potential for survivor bias, the work, published in this issue of Critical Care Medicine , by Paul et al (7) represents an important advance in assessing post-ICU HRQoL. In most countries, post-ICU care is performed by primary care physicians.…”

“…HRQoL is an outcome that requires careful study not only as a measurement of morbidity after critical illness but also as a measurement of cost-effectiveness. Once our patients have won the battle for survival, simple assessment tools such as those proposed by Paul et al (7) may be easily applied in primary care settings to help assess and treat the longer war that confronts so many survivors of critical illness as they strive to regain their quality of life.…”