Mortality and quality of life in the five years after severe sepsis

Abstract

IntroductionSevere sepsis is associated with high levels of morbidity and mortality, placing a high burden on healthcare resources. We aimed to study outcomes in the five years after severe sepsis.MethodsThis was a cohort study using data from a prospective audit in 26 adult ICUs in Scotland. Mortality was measured using clinical databases and quality of life using Short Form 36 (SF-36) at 3.5 and 5 years after severe sepsis.ResultsA total of 439 patients were recruited with a 58% mortality at 3.5 years and 61% mortality at 5 years. A total of 85 and 67 patients responded at 3.5 and 5 years follow-up, respectively. SF-36 physical component score (PCS) was low compared to population controls at 3.5 years (mean 41.8 (SD 11.8)) and at 5 years (mean 44.8 (SD 12.7)). SF-36 mental component score (MCS) was slightly lower than population controls at 3.5 years (mean 47.7 (SD 14.6)) and at 5 years after severe sepsis (mean 48.8 (SD 12.6)). The majority of patients were satisfied with their current quality of life (QOL) (80%) and all patients would be willing to be treated in an ICU again if they become critically ill despite many having unpleasant memories (19%) and recall (29%) of ICU events.ConclusionsPatients with severe sepsis have a high ongoing mortality after severe sepsis. They also have a significantly lower physical QOL compared to population norms but mental QOL scores were only slightly below population norms up to five years after severe sepsis. All survivors would be willing to be treated in an ICU again if critically ill. Mortality and QOL outcomes were broadly similar to other critically ill cohorts throughout the five years of follow-up.

Trial of Early, Goal-Directed Resuscitation for Septic Shock

“…1 Affected patients have high rates of death, complications, and resource utilization. [2][3][4][5] Since 2002, the Surviving Sepsis Campaign (SSC) has promoted best practice, including early recognition, source control, appropriate and timely antibiotic administration, and resuscitation with intravenous fluids and vasoactive drugs. [6][7][8] Resuscitation guidance is largely based on a 2001 singlecenter, proof-of-concept study by Rivers et al, which indicated that protocolized delivery of 6 hours of early, goal-directed therapy (EGDT) to patients presenting to the emergency department with early septic shock reduced hospital mortality and hospital stay.…”

"My (critically ill) patient has only a pneumonia" - the risk of oversimplification and the evidence of post-ICU syndrome

“…5 Critically ill patients, both during their ICU stay and mainly after ICU discharge, are prone to experiencing pain, neuropathy, weakness, skin breakdowns, persistent organ function support, depression, anxiety, sleep disorders, post-traumatic stress disorder, confusion, concentration deficit, memory deficit, attention deficit, low processing speed, low visual spatial resolution ability, and low execution ability. 4,6 Within 1 to 5 years after ICU discharge, these factors ultimately result in difficult locomotion, falls, depression, poor social skills, and in up to 34% of patients a cognitive dysfunction compatible with mild Alzheimer's disease. 7 This physical, neurological, and psychological clinical scenario has been called the post-ICU syndrome.…”

“…1 In spite of attractive biological plausibility, many pathophysiological-based interventions showed disappointing results after adequately designed randomized clinical trials; only adding costs to the care of the critically ill, without actual improvements in either survival neither quality of life. 2,3 Looking for patient-centered outcomes, many endpoints, such as long term physical, psychological and cognitive domains, as well as patient, family, and ICU team satisfaction with therapy have all been investigated, disclosing how devastating can an ICU stay be for the critically ill 4 and their families. 5 Critically ill patients, both during their ICU stay and mainly after ICU discharge, are prone to experiencing pain, neuropathy, weakness, skin breakdowns, persistent organ function support, depression, anxiety, sleep disorders, post-traumatic stress disorder, confusion, concentration deficit, memory deficit, attention deficit, low processing speed, low visual spatial resolution ability, and low execution ability.…”

Cardiac dysfunction in septic shock : Observational studies on characteristics and outcome

“…Even after ICU discharge, sepsis patients have a higher ongoing morbidity and mortality than the general public and other categories of ICU patients (79)(80)(81). The long-term consequences of septic organ dysfunction and the major causes of death after intensive care are, however, unclear.…”