Prediction Capability of Physical Assessment at Intensive Care Unit Discharge for Long-Term Functional Outcomes in Patients with Sepsis

BackgroundLong-term physical dysfunction common among intensive care unit (ICU) survivors and mortality remains a concern even after hospital discharge. Although early identification of patients at risk for these outcomes is essential, few studies have investigated whether physical assessments at ICU discharge can predict physical dysfunction or death at 3, 6, and 12 months after discharge. The purpose of this study was to examine the association between physical assessment at ICU discharge and the incidence of physical functional disability or death within 12 months after discharge.MethodsThis was a multicenter prospective cohort study of 21 ICUs in Japan. Patients with sepsis admitted to the ICU for >48 h were enrolled. The primary outcome was physical dysfunction (Barthel index ≤90) or death at 3, 6, and 12 months after discharge. Physical assessments at the time of ICU discharge included the Medical Research Council (MRC) score, handgrip strength, and the Barthel index. A multiple logistic regression model and area under the curve (AUC) were used.ResultsIn total, 300 ICU patients (median age, 74 years) were included. MRC score (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.96-0.99, cut-off: 46), hand grip strength (OR: 0.95, 95%CI: 0.92-0.98, cut-off: 12.0 kg), and Barthel index (OR: 0.96, 95%CI 0.95-0.98, cut-off: 15) were independent predictors of physical dysfunction or death at 12 months after hospital discharge and at 3 and 6 months. The Barthel index at ICU discharge showed the highest AUC for physical function or death at 12 months (0.718). The Barthel index and hand grip strength were also associated with cognitive dysfunction or mental disorders.ConclusionsIn ICU patients with sepsis, clinically available physical and muscle strength assessments at ICU discharge were significantly associated with physical dysfunction incidence or death over the first year of hospital discharge.<b>Trial registration number</b>: UMIN000041433.

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Journal
Journal of Intensive Care Medicine
Published
2025-11-05
DOI
https://doi.org/10.1177/08850666251383483
Primary Topic
Intensive Care Unit Cognitive Disorders
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article
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article

Prediction Capability of Physical Assessment at Intensive Care Unit Discharge for Long-Term Functional Outcomes in Patients with Sepsis

Hajime Katsukawa, Hidehiko Nakano, Mika Ono, Kenzo Ishii et al.
Journal of Intensive Care Medicine
Intensive Care Unit Cognitive Disorders
article

Prediction Capability of Physical Assessment at Intensive Care Unit Discharge for Long-Term Functional Outcomes in Patients with Sepsis

Hajime Katsukawa, Hidehiko Nakano, Mika Ono, Kenzo Ishii, Yasunari Morita, Masakazu Nitta, Keibun Liu, Ayaka Matsuoka, Yutaka Sakuda, Manabu Hanazawa, Toru Kotani, Nobutake Shimojo, Takashi Hongo, Yuhei Irie, Kazuki Akieda, Maiko Motoki, Kenji Oike, Tomohiro Hamagami, Kensuke Nakamura, Hiroshi Kamijo, Daisuke Kasugai, Shinichi Watanabe, Yukiko Tanaka, Takayuki Ogura, Daigo Shimakura
article en

Abstract

BackgroundLong-term physical dysfunction common among intensive care unit (ICU) survivors and mortality remains a concern even after hospital discharge. Although early identification of patients at risk for these outcomes is essential, few studies have investigated whether physical assessments at ICU discharge can predict physical dysfunction or death at 3, 6, and 12 months after discharge. The purpose of this study was to examine the association between physical assessment at ICU discharge and the incidence of physical functional disability or death within 12 months after discharge.MethodsThis was a multicenter prospective cohort study of 21 ICUs in Japan. Patients with sepsis admitted to the ICU for >48 h were enrolled. The primary outcome was physical dysfunction (Barthel index ≤90) or death at 3, 6, and 12 months after discharge. Physical assessments at the time of ICU discharge included the Medical Research Council (MRC) score, handgrip strength, and the Barthel index. A multiple logistic regression model and area under the curve (AUC) were used.ResultsIn total, 300 ICU patients (median age, 74 years) were included. MRC score (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.96-0.99, cut-off: 46), hand grip strength (OR: 0.95, 95%CI: 0.92-0.98, cut-off: 12.0 kg), and Barthel index (OR: 0.96, 95%CI 0.95-0.98, cut-off: 15) were independent predictors of physical dysfunction or death at 12 months after hospital discharge and at 3 and 6 months. The Barthel index at ICU discharge showed the highest AUC for physical function or death at 12 months (0.718). The Barthel index and hand grip strength were also associated with cognitive dysfunction or mental disorders.ConclusionsIn ICU patients with sepsis, clinically available physical and muscle strength assessments at ICU discharge were significantly associated with physical dysfunction incidence or death over the first year of hospital discharge.<b>Trial registration number</b>: UMIN000041433.

Journal of Intensive Care Medicine
SHOWA Medical University (JP), Shinshu University (JP), University of Tsukuba (JP), Okayama University (JP), University of Health Science (KH), Shiga University (JP), Saga University (JP), Fukuoka University (JP), Gifu University of Medical Science (JP), Tsuchiura Kyodo General Hospital (JP), Fukuoka University Hospital (JP), Fukuyama City Hospital (JP), University of Tsukuba Hospital (JP), Saiseikai Utsunomiya hospital (JP), Niigata University Medical and Dental Hospital (JP), Naha City Hospital (JP), Japanese Society of Medical Oncology (JP), Fuji Heavy Industries Health Insurance Society Ota Memorial Hospital (JP), Japanese Red Cross Narita Hospital (JP), Tsukuba Medical Center Hospital (JP), Toyooka Hospital (JP), Okayama Saiseikai General Hospital (JP), Hitachi General Hospital (JP), Nagoya Medical Center (JP), Ōtani University (JP), Nagoya University (JP), Kobe University (JP)
Openalex Percentile: Top 62%
Intensive Care Unit Cognitive Disorders
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