Physical function at ICU discharge and long-term outcomes in mechanically ventilated patients: A retrospective cohort study

OBJECTIVES: To evaluate whether the Chelsea Critical Care Physical Assessment (CPAx) score at ICU discharge is associated with long-term outcomes in survivors of mechanical ventilation. We assessed how a CPAx threshold of ≤ 31 predicts patient- and family-centered outcomes, including mortality, hospital readmission and caregiver burden during a follow-up. METHODS: A retrospective cohort study of adults who required invasive mechanical ventilation >24 h in an ICU between December 2021 and December 2024. Functional status was assessed within 24 h of ICU discharge using CPAx. Remote follow-up was conducted for up to one year after hospital discharge. Outcomes included post-discharge mortality, hospital readmission, caregiver burden, perceived sequelae and persistent symptoms. Survival was analyzed using Kaplan-Meier curves and Cox regression; secondary outcomes were evaluated using multivariable regression models. RESULTS: Of 1,669 mechanically ventilated patients, 676 underwent CPAx assessment, and 372 (67%) completed follow-up (137 days (95%-CI, 124-161; reverse Kaplan-Meier). Patients with CPAx ≤ 31 experienced markedly higher post-discharge mortality than those with higher scores (21.1% vs 5.7%; P < 0.001). Low functional performance independently predicted mortality (aHR, 2.42; 95% CI, 1.15-5.08; P = 0.020). Patients with low CPAx also had higher readmission rates (19.0% vs 10.0%; P = 0.035), although this association was not significant after multivariable adjustment. Caregiver burden increased significantly in patients with CPAx ≤ 31 (median Zarit, 14 vs 7; P = 0.028) and remained independently associated after adjustment (38.3% higher burden; P = 0.021). No differences were observed in perceived sequelae. CONCLUSIONS: Functional status at ICU discharge measured by CPAx independently predicts mortality during post-discharge follow-up and caregiver burden among mechanically ventilated survivors. A CPAx score ≤31 identifies a vulnerability phenotype that may guide risk stratification, discharge planning, and care pathways. IMPLICATIONS FOR CLINICAL PRACTICE: Routine assessment of physical function at ICU discharge may identify high-risk survivors who could benefit from targeted rehabilitation, structured discharge planning, and early post-ICU follow-up.