Quality of life of survivors from severe sepsis and septic shock may be similar to that of others who survive critical illness

Abstract

Correspondence: Cristina Granja, cristinagranja@oninet.pt R91 APACHE = Acute Physiology and Chronic Health Evaluation; EQ-5D = EuroQol five-dimension questionnaire; HR-QoL = health-related quality of life; ICU = intensive care unit; VAS = visual-analogue scale. AbstractIntroduction The objective of the present study was to compare the health-related quality of life (HR-QoL) of survivors from severe sepsis and septic shock with HR-QoL in others who survived critical illness not involving sepsis. Methods From March 1997 to March 2001, adult patients in an eight-bed medical/surgical intensive care unit (ICU) of a tertiary care hospital admitted with severe sepsis or septic shock (sepsis group; n = 305) were enrolled and compared with patients admitted without sepsis (control group; n = 392). Patients younger than 18 years (n = 48) and those whose ICU stay was 1 day or less (n = 453) were excluded. In addition, patients exhibiting nonsevere sepsis on admission were excluded (n = 87). Finally, patients who developed nonsevere sepsis or severe sepsis/septic shock after admission were also excluded (n = 88). Results In-hospital mortality rates were 34% in the sepsis group and 26% in the control group. There were no differences in sex, age, main activity (work status), and previous health state between groups. Survivors in the sepsis group had a significantly higher Acute Physiology and Chronic Health Evaluation II score on admission (17 versus 12) and stayed significantly longer in the ICU. A follow-up appointment was held 6 months after ICU discharge, and an EQ-5D (EuroQol five-dimension) questionnaire was administered. A total of 104 sepsis survivors and 133 survivors in the control group answered the EQ-5D questionnaire. Sepsis survivors reported significantly fewer problems only in the anxiety/depression dimension. Although there were no significant differences in the other dimensions of the EQ-5D, there was a trend towards fewer problems being reported by sepsis survivors. Conclusion Evaluation using the EQ-5D at 6 months after ICU discharge indicated that survivors from severe sepsis and septic shock have a similar HR-QoL to that of survivors from critical illness admitted without sepsis.

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

“…The most comparable studies are ones of general ICU cohorts [14,15,24] and of ARDS patients [17]. Broadly, these QOL scores are similar to those of other critically ill cohorts over this long follow-up [30]. It is interesting to note that the mental QOL scores are only slightly below the age- and sex-matched population control levels, which seems at odds with papers suggesting high levels of psychological morbidity and cognitive dysfunction after critical illness [9,12,15,17,24,32-35].…”

Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis

“…After title and abstract screening, 82 potentially relevant records were identified and after full text screening nine studies (10 papers [84][85][86][87][88][89][90][91][92][93] ) were considered eligible for inclusion ( Figure 22). This included one study 84 conducted for paediatric patients at the ED, one study 85 conducted in a paediatric ICU and six studies conducted in adult patients at the ICUs.…”

“…This included one study 84 conducted for paediatric patients at the ED, one study 85 conducted in a paediatric ICU and six studies conducted in adult patients at the ICUs. [86][87][88][89][90][91][92] Moreover, for one study 93 (abstract only) the specific setting (other than in-hospital) was not stated but the study was likely to have been conducted in an ICU setting, as it included patients with severe sepsis of presumed infectious origin; we have therefore assumed that this study was conducted in an ICU setting. The HRQoL studies are described in more detail below and summarised in Appendix 6.…”

“…All seven studies [86][87][88][89][90][91][92][93] that considered adult patients with sepsis, who were being treated in the ICU, used the European Quality of Life-5 Dimensions (EQ-5D) to elicit utility scores. Only one 93 of these studies (abstract only) reported short-term utility scores for a sepsis patient group (n = 93) that stayed in hospital (56% of the patients were in the hospital at day 30).…”

Patients with community acquired pneumonia admitted to European intensive care units: an epidemiological survey of the GenOSept cohort

“…It is also well-recognised that in CAP patients there is an increased death rate in the months following discharge [34], and in patients with sepsis there is significant excess mortality for at least five years [35]. In one study, the death rate of ICU patients between 28 days and 6 months was 9% in patients with sepsis, similar to the 8% seen in ICU patients without sepsis [36] and the 10% found in the present study. This compares to an increase in mortality from 18.2% at 30 days to 24.8% at 90 days in the subgroup of ICU patients in the PORT study [24] and an increase from 17.3% to 34.8% at 12 months in the GenIMS cohort of ICU patients [3].…”