Changes in health-related quality of life in severe sepsis

Introduction

Mortality from severe sepsis remains high despite ongoing searches to improve treatment modalities. Patients may survive sepsis at the cost of an impaired health-related quality of life (HRQOL). We hypothesized that HRQOL decreases during severe sepsis and intensive care (IC) treatment and remains impaired several months after IC survival and discharge.

Methods

We performed a long-term prospective study in patients with severe sepsis admitted to a 10-bed mixed IC unit in a 654-bed university-affiliated hospital. Patients were included if they met predefined criteria of severe sepsis and were admitted to the IC unit for > 48 hours. A population of sex-matched and age-matched healthy Dutch individuals served as control. The HRQOL was assessed using the Short-form 36 (SF-36), a generic instrument for measuring health status in different domains (i.e. physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health). Patients or proxies completed this questionnaire in the first 48 hours of admission [1]. Patients with established sepsis completed the SF-36 at IC discharge, hospital discharge, and 3 and 6 months after IC discharge. Demographic data and admission severity of illness (APACHE II score) were obtained. Statistical comparisons at admission and at 6 months were done with t tests, changes over time were assessed with both univariate and multivariate analysis of variance.

Results

Of the 170 patients with severe sepsis 95 could be evaluated 6 months after IC discharge (eight patients were lost to follow-up, 67 patients had died). In all dimensions of the SF-36, HRQOL changed significantly over time in survivors of severe sepsis (P < 0.05). These changes over time were not influenced by age or admission APACHE II score. A distinct pattern of a sharp decline during IC treatment and gradual improvement approaching normal functioning at 6 months after IC discharge was found in almost all HRQOL dimensions (i.e. physical functioning, role-limitation due to physical, vitality, general health, emotional role, social functioning, and mental health). Nevertheless, the average SF-36 scores of survivors of severe sepsis were still lower in six of the eight dimensions 6 months after IC discharge with the exception of social functioning and bodily pain compared with a normal population (all P < 0.05). Interestingly, the pre-admission HRQOL of severe sepsis survivors was already lower in three of the eight dimensions (role-physical, mental health and vitality) when compared with HRQOL in the normal population (all P < 0.01).

Conclusion

In survivors of severe sepsis, HRQOL showed a sharp multidimensional decline during IC treatment and gradual improvement approaching normal values 6 months after IC discharge. Pre-admission HRQOL was already lower in severe sepsis survivors than in the normal population. This interesting finding in view of the risk of surviving sepsis warrants further research.