The Impact of Centrally Acting Drug Burden at Discharge on Long-Term Outcomes Among ICU Survivors

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OBJECTIVES: ICU patients are at increased risk of inappropriate prescribing and high drug burden. These patients also often experience cognitive impairment, physical disability, and increased mortality after discharge. We investigated whether drug burden at hospital discharge was associated with worsened cognition, physical disability, and mortality among ICU survivors up to 6 months postdischarge. DESIGN: Substudy of three prospective cohort studies. SETTING: Tertiary academic medical center. PATIENTS: Adult patients with respiratory failure and/or shock discharged alive from the ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Drug burden was quantified using drug burden index (DBI) at admission, ICU transfer, and hospital discharge. Cognition was assessed with validated cognitive batteries. We assessed physical disability using Katz activities of daily living (ADL) and Functional Activities Questionnaire (FAQ), and 90-day mortality via chart review and surrogate. Binary logistic regression was used to investigate the association of discharge DBI on cognitive impairment, adjusting for prespecified covariates. Multivariable proportional odds logistic regression was used to investigate the association of discharge DBI on physical disability. Cox proportional hazards regression was used to investigate 90-day mortality. A total of 676 patients were included, 478 patients with cognitive assessment and 490 with physical assessment data. Median DBI increased throughout hospitalization with admission, ICU transfer, and hospital discharge DBI 1.96, 2.42, and 3.08, respectively. We did not find a statistically significant association between hospital discharge DBI and long-term cognitive impairment (odds ratio [OR] 1.25; 95% CI, 0.89-1.76; p = 0.20). There was no association between hospital discharge DBI and Katz activities of daily living (OR 1.08; 95% CI, 0.80-1.44; p = 0.62), FAQ (OR 1.15; 95% CI, 0.89-1.49; p = 0.29), or 90-day mortality (hazard ratio 0.87; 95% CI, 0.61-1.23; p = 0.42). CONCLUSIONS: Within our cohort of ICU survivors, we did not find a significant association of centrally acting drug burden measured by the DBI with long-term cognitive impairment, physical disability, or 90-day mortality.

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