Long-term Quality Of Life After Sepsis And Predictors Of Quality Of Life In Survivors With Sepsis

Objective: To investigate the quality of life in patients with sepsis within 2 years after discharge,comparing with the quality of life of critical patients without sepsis and the quality of life of the general people,and analyze the changes in quality of life of septic survivors over time and the predictors of quality of life,to guide practice,provide references for the treatment and rehabilitation of patients with sepsis,improve the quality of life of survivors,and reduce the economic burden of patients' families and the society.Methods: This was a prospective case-control study that screened the patients admitted to the ICU of Tianjin Third Central Hospital in from January 1,2014 to March 1,2017.The general population of China in the previous studies were also included.306 patients with sepsis as the observation group,and 306 age,gender and Charlson comorbidity index matched non-septic critically ill patients as the control group were enrolled during the same time,according to the inclusion criteria and the exclusion criteria.Sepsis was defined in accordance with the diagnostic criteria issued by the expert group such as the Society of Critical Care Medicine(SCCM)and the European Society of Intensive Care Medicine(ESICM)in 2001.At 3 mo,12 mo,and 24 mo after discharge,the Mos 36-item Short Form Health Survey(SF-36 scale),the Euroqol-5 dimension(EQ-5D scale),and the activities of daily living(ADL scale)were evaluated in face-to-face for the quality of life among survivors.The average score of the SF-36 scale of the general population similar to the age of sepsis patients in previous epidemiological studies was the reference for the quality of life of the general population in China.The quality of life of the observation group was compared with the quality of life of the control group and the quality of life of the general population.Reviewed the medical records and recorded the general data and clinical data of the patients who completed the follow-up: age,gender,Charlson Comorbidity Index(CCI),the number of comorbidities(the number of diseases in the Charlson Comorbidity Index),Acute Physiology and Chronic Health Evaluation II(APACHEII)score within 24 h of admission to the ICU,Sequential Organ Failure Assessment(SOFA)score and organs with acute dysfunction(defined as SOFA ?2),hypoxemia(defined as blood oxygen saturation <90%)and hypotension(defined as mean arterial pressure <60mm Hg),treatment of mechanical ventilation and continuous venous-venous hemofiltration.Binary logistic regression analysis was used to assess the impact of each of these indicators on quality of life in survivors of sepsis.Results: There were 210(68.6%)septic patients and 236(77.1%)non-septic critically ill patients discharged from hospital.At 3 mo,12 mo and 24 mo after discharge,there were 125,103 and 72 septic patients,and 140,112 80 non-septic patients in the follow-up.At 3 mo after discharge,the age and sex of patients with sepsis were similar to non-sepsis(age 58.8±18.1 vs 57.5±17.6,P=0.542,male 52.0% vs 51.4%,P=0.926).The observation group had a significantly higher Acute Physiology and Chronic Health Evaluation II score,Sequential Organ Failure Assessment,hospital stay and ICU stay than the control group(P<0.05).There were no significant differences in the eight dimensions of the SF36 scale,the EQ-5D index,and the activities of daily life scores between septic survivors and non-septic survivors(P>0.05),but the quality of life in septic survivors was significantly lower than the general population in China(P<0.05)in 2 years after discharge.Comparing the quality of life of patients who completed three visits between 3 mo and 24 mo,the general health(P=0.000)was statistically and clinically improved(score higher >5points)in the observation group,in the control group,the scores for physical functioning(P=0.008),bodily pain(P=0.002),general health(P=0.005),and vitality(P=0.000)also increased,but there were no clinically significance(score improvement <5points).we defined the quality of life as poor when the EQ-5D health utility scores of septic survivors was less than the median of 0.89.Univariate and multivariate analysis were performed in turn using binary logistic regression,found that age(OR,1.050;95%CI,1.022-1.078,P=0.000),female(OR,3.375;95%CI,1.434-7.941,P=0.005)and treatment with mechanical ventilation(? 5 days)(OR,3.412;95%CI,1.413,8.244,P=0.006)were the independent risk factors for the quality of life of septic survivors.Conclusion: The long-term quality of life of septic survivors was similar to that of non-sepsis critically ill patients.With the prolonged period of discharge,the general health of patients with sepsis improved slightly.Age,female and mechanical ventilation(?5days)were the predictors for the quality of life.