Long-term Quality of Life in Adult Patients Surviving Purpura Fulminans: An Exposed-Unexposed Multicenter Cohort Study

Abstract

Background Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated. Methods This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale–Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire. Results Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35–83) months and 44 (IQR, 35–72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36–53] vs 54 [IQR, 36–57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24–38] vs 52 [IQR, 42–56]; P = .001) and IADL scores (7 [IQR, 4–8] vs 8 [IQR, 7–8]; P = .021) compared with nonamputated patients. Conclusions Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health. Clinical Trials Registration NCT03216577.

Long-term quality of life in necrotizing soft-tissue infection survivors: a monocentric prospective cohort study

“…NSTI survivors were categorized as “admitted to the ICU” in case of ICU admission for NSTI at any time during their hospital stay. Patients admitted to the ICU were subsequently matched 1:1 or 1:2 on SAPS II (± 5 points) to a cohort of non-NSTI septic shock survivors from a previous study assessing QOL [ 18 ].…”

“…NSTI patients were not consistently in shock (76.2 vs 100%, p = 0.007) but had longer hospital stays [29 (16-37) vs 7.5 (4-17.5) days, p = 0.008] and shorter time elapsed between hospital discharge and phone interview than non-NSTI patients [1.1 (0.7-2.2) vs 4.5 (2.9-5.9) years, p = 0.002]. Strikingly, NSTI patients had higher HAD-D scores [3.5 (1-7) vs 3 (1.5-6), p = 0.048], and higher IES-R scores [18 (8-35) vs 8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), p = 0.049] with a higher proportion of IES-R scores ≥ 335 (33.3 vs 6.3%, p = 0.034). There were no differences regarding the selfassessed quality of life, as well as the ADL and IADL scores, the current place of residence, and the employment status or change in family status.…”

“…As expected, ICU patients showed significantly higher SAPS II scores than non-ICU patients [36 ) vs 19 ; p < 0.01], but no significant differences regarding other admission characteristics. Patients who had been admitted to the ICU showed higher median IES-R score [14 (7.5-34) vs 7 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), p = 0.035], pointing to more frequent post-traumatic stress disorders (see Additional file 3: Table S3). Their employment status was also significantly different (p = 0.023), with more frequent long-term disability (37.5 vs 12.0%) and less frequent full-time employment (8.3 vs 32.0%).…”

Health‐related quality of life and long‐term sequelae in survivors of epidermal necrolysis: an observational study of 57 patients

“…Survivors of EN were classified as ‘admitted to the ICU’ or ‘not admitted to the ICU’ (the latter received treatment in the dermatology department only). Patients who were admitted to the ICU were subsequently matched 1 : 1 or 1 : 2 by age (± 10 years) and sex to a cohort of non‐EN septic shock survivors from a previous study assessing the HRQoL of patients with sepsis that used an exposed–unexposed design . Patients who did not speak French were not included.…”

“…To assess patient‐reported outcomes, the following questionnaires were administered during phone interviews with survivors of EN (including those who were admitted to the ICU and those who were not) and survivors of septic shock, as previously reported:…”