Functional Disability and Predictors of Post-Intensive Care Syndrome During the Subacute Recovery Phase In a Middle-Income Country

Background

Post-Intensive Care Syndrome (PICS) contributes substantially to long-term disability among ICU survivors, although evidence from low- and middle-income countries (LMICs) remains limited. This study examined the prevalence and predictors of physical PICS during the subacute recovery phase in Thailand, representing a middle-income healthcare context.

Methods

A cross-sectional study was conducted among adult medical-ICU survivors at a tertiary hospital between March 2024 and February 2025. Patients admitted > 48 hours and surviving to hospital discharge were assessed for functional status at 3–9 months post-discharge using the Simplified Barthel Index (SBI). Univariable and multivariable logistic regression analyses identified independent predictors of physical PICS.

Results

Of 94 participants, 21 (21.3 %) met criteria for physical PICS. The median age was 59.5 years, and patients with PICS were significantly older than those without (72 vs 56 years, p < 0.01). Independent predictors included older age (aOR 1.07 per year, 95 % CI 1.02–1.13), prolonged mechanical ventilation (aOR 2.07 per day, 95 % CI 1.21–3.56), and longer hospital stay (aOR 1.17 per day, 95 % CI 1.02–1.34). Female sex was associated with higher risk (aOR 0.18; 95 % CI 0.03–0.99), whereas hyperglycemia showed an inverse relationship (aOR 0.08; 95 % CI 0.01–0.57).

Conclusions

Physical PICS affected one-fifth of ICU survivors during the subacute phase and was associated with advanced age, prolonged ventilation, and extended hospitalization. These findings underscore the need for early rehabilitation strategies and long-term follow-up systems for ICU survivors, particularly in LMIC settings where survivorship resources remain limited.

Key Messages

• Post-Intensive Care Syndrome (PICS) contributes to long-term physical disability among ICU survivors, but data from low- and middle-income countries (LMICs) are limited.

• This study examined physical PICS during the subacute recovery phase (3–9 months post-discharge)—a period rarely explored in global literature.

• Older age, prolonged mechanical ventilation, and extended hospital stay were identified as independent predictors of post-ICU disability.

• Male sex appeared protective, while hyperglycemia reflected metabolic patterns specific to the study population rather than a causal factor.

• These findings emphasize the need for structured post-ICU follow-up and rehabilitation systems to improve survivorship outcomes in resource-limited healthcare settings.