The Development of Chronic Critical Illness Determines Physical Function, Quality of Life, and Long-Term Survival Among Early Survivors of Sepsis in Surgical ICUs

Abstract

Objectives: This study sought to examine mortality, health-related quality of life, and physical function among sepsis survivors who developed chronic critical illness.

Design: Single-institution, prospective, longitudinal, observational cohort study assessing 12-month outcomes.

Setting: Two surgical/trauma ICUs at an academic tertiary medical and level 1 trauma center.

Patients: Adult critically ill patients that survived 14 days or longer after sepsis onset.

Interventions: None.

Measurements and main results: Baseline patient characteristics and function, sepsis severity, and clinical outcomes of the index hospitalization were collected. Follow-up physical function (short physical performance battery; Zubrod; hand grip strength) and health-related quality of life (EuroQol-5D-3L, Short Form-36) were measured at 3, 6, and 12 months. Hospital-free days and mortality were determined at 12 months. We compared differences in long-term outcomes between subjects who developed chronic critical illness (≥ 14 ICU days with persistent organ dysfunction) versus those with rapid recovery. The cohort consisted of 173 sepsis patients; 63 (36%) developed chronic critical illness and 110 (64%) exhibited rapid recovery. Baseline physical function and health-related quality of life did not differ between groups. Those who developed chronic critical illness had significantly fewer hospital-free days (196 ± 148 vs 321 ± 65; p < 0.0001) and reduced survival at 12-months compared with rapid recovery subjects (54% vs 92%; p < 0.0001). At 3- and 6-month follow-up, chronic critical illness patients had significantly lower physical function (3 mo: short physical performance battery, Zubrod, and hand grip; 6 mo: short physical performance battery, Zubrod) and health-related quality of life (3- and 6-mo: EuroQol-5D-3L) compared with patients who rapidly recovered. By 12-month follow-up, chronic critical illness patients had significantly lower physical function and health-related quality of life on all measures.

Conclusions: Surgical patients who develop chronic critical illness after sepsis exhibit high healthcare resource utilization and ultimately suffer dismal long-term clinical, functional, and health-related quality of life outcomes. Further understanding of the mechanisms driving the development and persistence of chronic critical illness will be necessary to improve long-term outcomes after sepsis.

Trial registration: ClinicalTrials.gov NCT02276417.

Figure 1.

CONSORT diagram and retention rates of 12-month follow-up.

Figure 2.

12-month survival among chronic critical illness (CCI) versus rapid recovery (RAP) patients.

Figure 3.. 12-month performance status differences in CCI versus RAP patients.

Zubrod Score; (0) Asymptomatic [Fully active, able to carry out all pre-disease activities without restriction], (1) Symptomatic but completely ambulatory [Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature], (2) Symptomatic, <50% in bed during the day [Ambulatory and capable of all self-care but unable to carry out any work activities], 3) Symptomatic, >50% in bed, but not bedbound [Capable of only limited self-care, confined to bed or chair 50% or more of waking hours], 4) Bedbound [Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair], 5) Death. CCI, chronic critical illness; RAP, rapid recovery; *, p<0.05.