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Title: Anaemia and its impact on recovery and quality of life in survivors of critical illness
Author: Bateman, Anthony Philip
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2011
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Survivors of critical illness experience a significant burden of persisting physical, psychological and cognitive dysfunction during recovery as a result of the interaction between factors relating to the ICU environment, the invasive treatments required and the pre-morbid health of the patient. Little is known about the long term complications of critical illness and the impact they have on recovery. Physical morbidity is common due to generalised muscle atrophy and weakness due to the catabolic state and immobility associated with critical illness. There is a high prevalence of anaemia in critically ill patients due to iatrogenic blood loss and the inflammatory state impairing erythrogenesis but little is known about its persistence and effects on physical recovery. The studies presented in this thesis aimed to evaluate the prevalence of anaemia and physical morbidity in survivors of critical illness and to explore the potential contribution of anaemia to impaired physical function and poor quality of life during recovery. The TRAC study was a single centre, prospective, observational cohort study aimed to determine the prevalence and pathophysiology of anaemia following critical illness. Indices of erythropoiesis, inflammation and health related quality of life were measured over 6 months and showed that anaemia persists up to 6 months and was associated with evidence of an ongoing inflammatory state and impairment of erythropoiesis. Health related quality of life was also noted to be impaired raising the possibility that anaemia may affect quality of life following critical illness. The Ps and Qs study was a two centre, prospective observational study aimed to investigate actual and perceived physical function during recovery from critical illness and the associated impact upon health related quality of life. Simple measures of psychological state and organ function were also recorded. The study showed that survivors of critical illness had a normal pre-morbid perceived physical function but a reduced quality of life. Both were significantly worsened by the critical illness and remained impaired up to 6 months. Actual physical function in our heterogeneous population was reduced to levels associated with very severe chronic disease. There was evidence of a significant level of post traumatic stress disorder, persisting anaemia and malnutrition but no other organ dysfunction during recovery. Further analysis of the Ps and Qs data was performed to investigate potential links between anaemia, physical function and quality of life. Perceived physical function, actual physical function and quality of life were all impaired in the presence of anaemia. Additionally, anaemia was associated with a longer ICU stay and increased age but not with severity of illness or the degree of organ failure developed during ICU stay. The persistence of anaemia was also associated with malnutrition and inflammation. In conclusion these studies show that physical function and health related quality of life are dramatically affected by critical illness. There is a high prevalence of anaemia in survivors of critical illness, which is associated with ongoing inflammation and impaired erythropoiesis. Importantly, the data also show that quality of life and physical recovery are further impaired in the presence of anaemia. Further studies are required to evaluate the effects of anaemia on physical recovery from critical illness and investigate the potential benefits of treatments for anaemia on physical rehabilitation.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available