February 21, 2017


Performance status (PS) as used by Dr. Zampieri and colleagues (1) is an approximation of functional capacity. PS impairment has previously been associated with increased risk of mortality in various critically ill patient populations (2-4).

In their recently published retrospective study in Intensive Care Medicine, Zampieri et al. (1) assessed the correlation between PS impairment and various health outcome parameters in critically ill patients. In addition, the authors evaluated the prognostic value of adding PS-results to the SAPS-3 score.

The authors conducted a retrospective analysis of the ORCHESTRA study cohort, involving 59,693 patients from 78 ICUs. Performance status was assessed according to Eastern Cooperative Oncology Group scale (ECOG), a simple measurement of independence in daily life.

Performance Status was found to be strongly associated with various outcome parameters, including overall, hospital, as well as ICU-mortality. This association was still present after adjustment for multiple confounders, like age, severity of illness and comorbidities. Including PS-scores to the SAPS-3 resulted in an improvement in prognostic value.

The study results are in line with previous investigations, although these studies were more limited in their significance, as they were usually focused on specific patient subgroups (2-4). 

Besides its' retrospective nature, the study is limited by the fact that PS was assessed only in the week before hospital admission. This could potentially overestimate functional impairment due to the proximity of the assessment to the onset of critical illness.

For clinicians and researchers, these data are likewise important. When interpreting study-results and treatment-efficacies as well as planning studies, functional-status might interfere and be an important, frequently overlooked covariate. Admission status in this context is commonly used but limited to comorbidities. Particularly in elderly patients with a higher incidence of frailty, functional status seems to be of utmost interest. 

Key messages:
•    More than a quarter of the assessed patients had moderate or severe PS impairments before critical illness
•    An impairment in performance status is independently associated with increased ICU-mortality
•    Assessment of performance status can help clinicians to gain a more accurate picture of the patient’s overall functional capacity

This article review was submitted by Julius Grunow (ESICM NEXT member), Max Rosenthal (ESICM NEXT member) and Björn Weiss (ESICM NEXT Chair) on behalf of the ERJC.


1. Zampieri FG, Bozza FA, Moralez GM, Mazza DD, Scotti AV, Santino MS, et al. The effects of performance status one week before hospital admission on the outcomes of critically ill patients. Intensive Care Med 2017, Jan;43(1):39-47.
2. Rosolem MM, Rabello LS, Lisboa T, Caruso P, Costa RT, Leal JV, et al. Critically ill patients with cancer and sepsis: Clinical course and prognostic factors. J Crit Care 2012, Jun;27(3):301-7.
3. Torres VB, Azevedo LC, Silva UV, Caruso P, Torelly AP, Silva E, et al. Sepsis-Associated outcomes in critically ill patients with malignancies. Ann Am Thorac Soc 2015, Aug;12(8):1185-92.
4. Zampieri FG, Colombari F. The impact of performance status and comorbidities on the short-term prognosis of very elderly patients admitted to the ICU. BMC Anesthesiol 2014;14:59.
5. Boeck S, Hinke A, Wilkowski R, Heinemann V. Importance of performance status for treatment outcome in advanced pancreatic cancer. World J Gastroenterol 2007, Jan 14;13(2):224-7.


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