One-year survival and resource use after XXXX : impact of organ failure and residual organ dysfunction in a cohort study in Brazil.

@entity1 @entity146 @entity5 @entity3124 @entity1213 @entity1030
INTRODUCTION: In this study, we evaluated the impacts of organ failure and residual dysfunction on 1-year survival and health care resource use using @entity1213 ( @entity1213 ) discharge as the starting point. METHODS: We conducted a historical cohort study, including all adult @entity1 discharged alive after at least 72 h of @entity1213 stay in a tertiary teaching hospital in Brazil. The starting point of follow-up was @entity1213 discharge. Organ failure was defined as a value of 3 or 4 in its corresponding component of the Sequential Organ Failure Assessment score, and residual organ dysfunction was defined as a score of 1 or 2. We fit a multivariate flexible Cox model to predict 1-year survival. RESULTS: We analyzed 690 @entity1 . Mortality at 1 year after discharge was 27%. Using multivariate modeling, age, @entity1030 , @entity5 and albumin at @entity1213 discharge were the main determinants of 1-year survival. Age and organ failure were non-linearly associated with survival, and the impact of organ failure diminished over time. We conducted a subset analysis with 561 @entity1 (81%) discharged without organ failure within the previous 24 h of discharge, and the number of residual organs in dysfunction remained strongly associated with reduced 1-year survival. The use of health care resources among hospital survivors was substantial within 1 year: 40% of the @entity1 were rehospitalized, 52% visited the emergency department, 90% were seen at the outpatient clinic, 14% attended rehabilitation outpatient services, 11% were followed by the psychological or @entity146 service and 7% used the day hospital facility. Use of health care resources up to 30 days after hospital discharge was associated with the number of organs in dysfunction at @entity1213 discharge. CONCLUSIONS: Organ failure was an important determinant of 1-year outcome of critically ill survivors. Nevertheless, the impact of organ failure tended to diminish over time. Resource use after @entity3124 was elevated among @entity1213 survivors, and a targeted action is needed to deliver appropriate care and to reduce the late @entity3124 .
