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Randomized Controlled Trial
. 2016 Aug;44(8):1461-7.
doi: 10.1097/CCM.0000000000001658.

Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials

Sachin Yende  1 , Shamly Austin, Andrew Rhodes, Simon Finfer, Steven Opal, Taylor Thompson, Fernando A Bozza, Steven P LaRosa, V Marco Ranieri, Derek C Angus
Affiliations
Randomized Controlled Trial

Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials

Sachin Yende et al. Crit Care Med. 2016 Aug.

Abstract

Objectives: To describe the quality of life among sepsis survivors.

Design: Secondary analyses of two international, randomized clinical trials (A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis [derivation cohort] and PROWESS-SHOCK [validation cohort]).

Setting: ICUs in North and South America, Europe, Africa, Asia, and Australia.

Patients: Adults with severe sepsis. We analyzed only patients who were functional and living at home without help before sepsis hospitalization (n = 1,143 and 987 from A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, respectively).

Interventions: None.

Measurements and main results: In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, the average age of patients living at home independently was 63 and 61 years; 400 (34.9%) and 298 (30.2%) died by 6 months. In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis, 580 patients had a quality of life measured using EQ-5D at 6 months. Of these, 41.6% could not live independently (22.7% were home but required help, 5.1% were in nursing home or rehabilitation facilities, and 5.3% were in acute care hospitals). Poor quality of life at 6 months, as evidenced by problems in mobility, usual activities, and self-care domains were reported in 37.4%, 43.7%, and 20.5%, respectively, and the high incidence of poor quality of life was also seen in patients in PROWESS-SHOCK. Over 45% of patients with mobility and self-care problems at 6 months in A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis died or reported persistent problems at 1 year.

Conclusions: Among individuals enrolled in a clinical trial who lived independently prior to severe sepsis, one third had died and of those who survived, a further one third had not returned to independent living by 6 months. Both mortality and quality of life should be considered when designing new interventions and considering endpoints for sepsis trials.

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Figures

Figure 1
Figure 1
Flow chart describing selection of analyses cohorts and number of patients with quality of life measures
Figure 2
Figure 2
Proportion of patients who reported problems with mobility, self-care, and usual activities for all patients (panel A) who were functional prior to onset of severe sepsis and in the subsets that were young (<45 years old, panel B) and without chronic diseases (panel C).
See this image and copyright information in PMC

Comment in

  • Surviving Severe Sepsis: Is That Enough?
    Anderson-Shaw L. Anderson-Shaw L. Crit Care Med. 2016 Aug;44(8):1603-4. doi: 10.1097/CCM.0000000000001764. Crit Care Med. 2016. PMID: 27428119 No abstract available.
  • Functional Limitations Do Not Mean Poor Quality of Life.
    Riem R, Lakhal K. Riem R, et al. Crit Care Med. 2017 Jan;45(1):e113. doi: 10.1097/CCM.0000000000002139. Crit Care Med. 2017. PMID: 27984292 No abstract available.
  • The authors reply.
    Yende S, Rhodes A, Angus DC. Yende S, et al. Crit Care Med. 2017 Jan;45(1):e113-e114. doi: 10.1097/CCM.0000000000002167. Crit Care Med. 2017. PMID: 27984293 No abstract available.

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