Clinician perception of long‐term survival at the point of critical care discharge: a prospective cohort study

Critical care survivors suffer persistent morbidity and increased risk of mortality compared to the general population. However, there are no standardised tools to identify at risk patients. Our aim was to establish whether the Sabadell score, a simple tool applied upon critical care discharge, is independently associated with five-year mortality through a prospective observational cohort study of adults admitted to a general critical care unit in Liverpool, United Kingdom. Sabadell score was applied to all patients from September 2011 to December 2017 and our primary outcome was five-year mortality assessed using a multivariable flexible parametric survival analysis adjusted for demographics, and clinically relevant covariates. There were 5954 included patients with a minimum of 18 months follow-up. Mean (SD) age was 59.5 (34) and 3397 (57.1%) patients were male. We categorised 2287 (38.4%) as Sadabell zero, 2854 (47.9%) as Sadabell one, 629 (10.5%) as Sadabell two and 183 (3.1%) as Sadabell three. Adjusted hazard ratios for mortality were 2.1 (95%CI 1.9–2.4), 4.0 (95%CI 3.4–4.6) and 21.0 (95%CI 17.2–25.7), respectively. A Sabadell score of three was associated with 99.9%, 99.5%, 98.5% and 87.4% mortality at five years for patients aged  80, 60-79, 40-59 and 16-39 respectively. A Sabadell score of two was associated with 71.0%, 52.7%, 44.8% and 23.7% five-year mortality for these age categories. Sabadell score is independently associated with five-year survival after critical care discharge. These findings could be used to guide provision of increased support for patients after critical care discharge and/or informed discussions with patients and relatives about dying to ascertain their future wishes.