Risk factors for post-intensive care syndrome: A systematic review and meta-analysis

Aust Crit Care. 2020 May;33(3):287-294. doi: 10.1016/j.aucc.2019.10.004. Epub 2019 Dec 12.


Objective: The objective of this study was to identify the risk factors for each area of post-intensive care syndrome (PICS) and to determine their effect size.

Review method used: This study used systematic review and meta-analysis.

Data sources: PubMed, CINAHL, EMBASE, PsycINFO, and Cochrane Library were searched.

Review methods: Eighty-nine studies were selected for the review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PICS areas and risk factors reported in the individual studies were reviewed and categorised. We used the Newcastle-Ottawa Scale to evaluate the quality of studies. The effect size of each risk factor was calculated as odds ratio (OR).

Results: There were 33 mental health studies, 15 cognitive impairment studies, 32 physical impairment studies, eight studies on two areas, and one study on all three areas. Sixty risk factors were identified, including 33 personal and 27 intensive care unit (ICU)-related factors. Significant risk factors for mental health included female sex (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.12-10.17), previous mental health problems (OR = 9.45, 95% CI: 2.08-42.90), and negative ICU experience (OR = 2.59, 95% CI: 2.04-3.28). The only significant risk factor for cognitive impairment was delirium (OR = 2.85, 95% CI: 1.10-7.38). Significant risk factors for physical impairment included older age (OR = 2.19, 95% CI: 1.11-4.33), female sex (OR = 1.96, 95% CI: 1.32-2.91), and high disease severity (OR = 2.54, 95% CI: 1.76-3.66).

Conclusions: Although PICS is a multidimensional concept, each area has been studied separately. Significant risk factors for PICS included older age, female sex, previous mental health problems, disease severity, negative ICU experience, and delirium. To prevent PICS, the multidisciplinary team should pay attention to modifiable risk factors such as delirium and patients' ICU experience.

Keywords: Intensive care units; Meta-analysis; Post-intensive care syndrome; Risk factors; Survivors.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Critical Illness*
  • Humans
  • Risk Factors

Supplementary concepts

  • postintensive care syndrome