Influence of quality of intensive care on quality of life/return to work in survivors of the acute respiratory distress syndrome: prospective observational patient cohort study (DACAPO)
Authors: Apfelbacher Christian , Brandstetter Susanne , Blecha Sebastian , Dodoo-Schittko Frank , Brandl Magdalena , Karagiannidis Christian , Quintel Michael , Kluge Stefan , Putensen Christian , Bercker Sven , Ellger Björn , Kirschning Thomas , Arndt Christian , Meybohm Patrick , Weber-Carstens Steffen ,   the DACAPO study group, Bickenbach Johannes , Beeker Thorben , Schürholz Tobias , Pezechk Jessica , Schloer Jens , Jaschinski Ulrich , Kummer Ilse , Kuckein Oliver , Weber-Carstens Steffen , Goldmann Anton , Angermair Stefan , Stoycheva Krista , Brederlau Jörg , Rieckehr Nadja , Schreiber Gabriele , Haennicke Henriette , Bach Friedhelm , Gummelt Immo , Haas Silke , Middeke Catharina , Vedder Ina , Klaproth Marion , Adamzik Michael , Karlik Jan , Martini Stefan , Robitzky Luisa , Putensen Christian , Muders Thomas , Lohmer Ute , Dembinski Rolf , Schäffner Petra , Wulff-Werner Petra , Landsiedel-Mechenbier Elke , Nickoleit-Bitzenberger Daniela , Silber Ann-Kathrin , Ragaller Maximilian , de Abreu Marcello Gama , Ulbricht Alin , Reisbach Linda , Zacharowski Kai , Meybohm Patrick , Lindau Simone , Mutlak Haitham , Hötzel Alexander , Kalbhenn Johannes , Metz Christoph , Haschka Stefan , Rauch Stefan , Quintel Michael , Harnisch Lars-Olav , Baumann Sophie , Kernchen Andrea , Friesecke Sigrun , Maletzki Sebastian , Kluge Stefan , Boenisch Olaf , Frings Daniel , Füllekrug Birgit , Jahn Nils , Kampe Knut , Ringeis Grit , Singer Brigitte , Wüstenberg Robin , Ahrens Jörg , Ruschulte Heiner , Gerdes Andre , Groß Matthias , Wiesner Olaf , Bayat-Graw Aleksandra , Brenner Thorsten , Schmitt Felix , Lipinski Anna , Henzler Dietrich , Eickmeyer Klaas , Krebs Juliane , Rodenberg Iris , Groesdonk Heinrich , Meiers Kathrin , Salm Karen , Volk Thomas , Fischer Stefan , Redwan Basam , Schmölz Martin , Schumann-Stoiber Kathrin , Eberl Simone , Lenz Gunther , von Wernitz-Keibel Thomas , Zackel Monika , Bloos Frank , Bloos Petra , Braune Anke , Haucke Anja , Noack Almut , Kolanos Steffi , Kuhnsch Heike , Knuhr-Kohlberg Karina , Gehling Markus , Haller Mathias , Sturm Anne , Rossenbach Jannik , Schädler Dirk , D’Aria Stefanie , Karagiannidis Christian , Straßmann Stephan , Windisch Wolfram , Annecke Thorsten , Herff Holger , Schütz Michael , Bercker Sven , Reising Hannah , Dathe Mandy , Schlegel Christian , Lichy Katrin , Zink Wolfgang , Kötteritzsch Jana , Bodenstein Marc , Mauff Susanne , Straub Peter , Strang Christof , Prätsch Florian , Hachenberg Thomas , Kirschning Thomas , Friedrich Thomas , Mangold Dennis , Arndt Christian , Koch Tilo , Haake Hendrik , Offermanns Katrin , Friederich Patrick , Bingold Florian , Irlbeck Michael , Zwissler Bernhard , Kaufmann Ines , Bogdanski Ralph , Kapfer Barbara , Heim Markus , Edenharter Günther , Ellger Björn , Bause Daniela , Gerresheim Götz , Muschner Dorothea , Christ Michael , Geise Arnim , Beiderlinden Martin , Heuter Thorsten , Wipfel Alexander , Kargl Werner , Harth Marion , Englmeier Christian , Bein Thomas , Blecha Sebastian , Thomann-Hackner Kathrin , Zeder Marius , Stephan Markus , Glaser Martin , Häberle Helene , Bracht Hendrik , Heer Christian , Mast Theresa , Kredel Markus , Müllenbach Ralf , Sebök Phillip , Thomann-Hackner Kathrin , Loss Julika , Graf Bernhard , Leitzmann Michael , Pfeifer Michael , Bein Simon , Brunnthaler Vreni , Forster Carina , Hertling Stefanie , Höhne Sophie , Schimmele Carolin , Valletta Elisa , Drewitz Philipp , Eberle Chiara , Slutsky Arthur , Bein Thomas 
Published: June 2020

Abstract
Background
Significant long-term reduction in health-related quality of life (HRQoL) is often observed in survivors of the acute respiratory distress syndrome (ARDS), and return to work (RtW) is limited. There is a paucity of data regarding the relationship between the quality of care (QoC) in the intensive care unit (ICU) and both HRQoL and RtW in ARDS survivors. Therefore, the aim of our study was to investigate associations between indicators of QoC and HRQoL and RtW in a cohort of survivors of ARDS.

Methods
To determine the influence of QoC on HRQoL and RtW 1 year after ICU-discharge, ARDS patients were recruited into a prospective multi-centre patient cohort study and followed up regularly after discharge. Patients were asked to complete self-report questionnaires on HRQoL (Short Form 12 physical component scale (PCS) and mental component scale (MCS)) and RtW. Indicators of QoC pertaining to volume, structural and process quality, and general characteristics were recorded on ICU level. Associations between QoC indicators and HrQoL and RtW were investigated by multivariable linear and Cox regression modelling, respectively. B values and hazard ratios (HRs) are reported with corresponding 95% confidence intervals (CIs).

Results
877 (of initially 1225 enrolled) people with ARDS formed the DACAPO survivor cohort, 396 were finally followed up to 1 year after discharge. The twelve-month survivors were characterized by a reduced HRQoL with a greater impairment in the physical component (Md 41.2 IQR [34–52]) compared to the mental component (Md 47.3 IQR [33–57]). Overall, 50% of the patients returned to work. The proportion of ventilated ICU patients showed significant negative associations with both 12 months PCS (B = − 11.22, CI −20.71; − 1,74) and RtW (HR = 0,18, CI 0,04;0,80). All other QoC indicators were not significantly related to outcome.

Conclusions
Associations between ICU QoC and long-term HrQoL and RtW were weak and largely non-significant. Residual confounding by case mix, treatment variables before or during ICU stay and variables pertaining to the post intensive care period (e.g. rehabilitation) cannot be ruled out.

Trial registration
Clinicaltrials.govNCT02637011.
(December 22, 2015, retrospectively registered)