Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma

Abstract

Introduction: Our aim was to determine long-term survival and quality of life of patients admitted to a surgical intensive care unit (ICU) because of sepsis or trauma.

Methods: This was an observational study conducted in an 11-bed, closed surgical ICU at a 860-bed teaching general hospital over a 1-year period (January 2003 to December 2003). Patients were divided into two groups according to admission diagnoses: group 1 included patients with sepsis; and group 2 included patients with trauma (polytrauma, multiple trauma, head injury, or spinal injury). Quality of life was assessed after 2 years following ICU admission using the EuroQol 5D questionnaire.

Results: A total of 164 patients (98 trauma patients and 66 patients with sepsis) were included in the study. Trauma patients were younger than patients with sepsis (53 +/- 21 years versus 64 +/- 13 years; P < or = 0.001). There was no significant difference between groups in Acute Physiology and Chronic Health Evaluation II score or length of stay in the surgical SICU. Trauma patients stayed longer on the general ward (35 +/- 44 days versus 17 +/- 24 days; P < 001). Surgical ICU survival, in-hospital survival, and post-hospital and cumulative 2-year survival were lower in the sepsis group than in the trauma group (surgical ICU survival: 60% versus 74%; in-hospital survival: 42% versus 62%; post-hospital survival: 78% versus 92%; cumulative 2-year survival: 33% versus 57%; P < 0.05). There was no significant difference in quality of life in all five dimensions of the EuroQol 5D between groups: 60% of patients had signs of depression, almost 60% had problems in usual activities and 56% had pain.

Conclusion: Patients with sepsis treated in a surgical ICU have higher short-term and long-term mortality than do trauma patients. However, quality of life is reduced to the same level in both groups.

Figure 1

Surgical ICU mortality. The Kaplan-Meier survival curve shows that patients with sepsis had higher surgical ICU mortality than did patients with trauma. ICU, intensive care unit.

Figure 2

In-hospital mortality. The Kaplan-Meier survival curve shows that patients with sepsis had higher in-hospital mortality than did patients with trauma.

Figure 3

In-hospital mortality, controlling for age. The Cox survival analysis shows that patients with sepsis had higher in-hospital mortality than did trauma patients, after controlling for age.

Figure 4

Post-hospital mortality. The Kaplan-Meier survival curve shows that patients with sepsis had higher post-hospital mortality than did patients with trauma.

Figure 5

Cumulative 2-year mortality. The Kaplan-Meier survival curve shows that patients with sepsis had higher cumulative 2-year mortality than did patients with trauma.

Figure 6

EuroQol 5D profile after 2 years. The EuroQol 5D profile is dichotomized into 'no problems' and 'moderate/extreme problems'. After 2 years there was no significant difference between the sepsis group and the trauma group.