Pre-admission quality of life as predictor of outcome after acute care: the role of emotional well-being

Purpose: We sought to investigate whether pre-admission quality of life could act as a predictor of mortality among acutely ill patients, and which dimension of QOL has the greater impact on outcomes. Methods: Prospective cohort study including patients admitted to an acute medical unit of Rabat Ibn Sina University Hospital, Morocco, between June and September 2014. Characteristics of patients were recorded at admission. The primary exposure was pre-admission quality of life recorded using Euroqol five dimensions three level (EQ-5 D-3 L) and the primary outcome was 90-day mortality. We fit a Cox proportional hazards model to assess their association. We constructed six prediction models; each model included either EQ5D index or one of the five dimensions. We allowed all continuous variables to have a non-linear relationship with the primary outcome using restricted cubic spline with three knots. Results: We included 251 patients. The mean EQ5D index was 0.46 +/- 0.5. The design of each prediction model was based on the significant findings of the univariate analysis including; bedside EQ5D index or one of the five dimensions of the EQ5D; age, history of chronic disease, Charlson Comorbidity Index and hemoglobinemia. Multi-variate Cox proportional adjusted hazard ratio (HR) derived from the six models, identified that EQ5D index was independently associated with 90-day mortality (HR: 0.48; 95% CI: 0.25; 0.91, P = 0.02), and that anxiety and depression dimension has the greater impact on outcome (HR: 2.97; 95% CI: 1.38; 6.41, P = 0.005). Conclusions: This study revealed that pre-admission health-related quality of life (HRQoL), and particularly pre-admission psychological HRQoL was associated with outcome of acutely ill patients 90 days after discharge.