Health-Related Quality of Life Among Survivors of Pediatric Sepsis

Abstract

Objectives: Mortality from pediatric sepsis has steadily declined over the past several decades; however, little is known about morbidity among survivors. We aimed to determine the prevalence of and risk factors for failure to recover to baseline health-related quality of life following community-acquired pediatric sepsis.

Design: Retrospective cohort study.

Setting: Seattle Children's Hospital.

Patients: Children aged 1 month to 21 years admitted to the inpatient wards or ICUs from 2012 to 2015 who met 2005 consensus sepsis criteria within 4 hours of hospitalization and were enrolled in the hospital's Outcomes Assessment Program with baseline, admission, and post-discharge health-related quality of life data available.

Interventions: None.

Measurements and main results: We assessed health-related quality of life with the Pediatric Quality of Life Inventory for pre-admission baseline, admission, and post-discharge (median, 31 d) status. We determined associations between patient and illness characteristics with failure to recover within 4.5 points of baseline at follow-up (the minimum clinically significant difference between two scores). Of 790 patients, 23.8% failed to recover to baseline health-related quality of life at follow-up. Factors associated with failure to recover were septic shock, older age, private insurance, complex chronic disease, immune compromise, CNS infection or bacteremia, ICU admission, and longer length of stay. On multivariable analysis controlling for time to follow-up, failure to recover was independently associated with septic shock (relative risk, 1.79; 95% CI, 1.24-2.58), older age (relative risk, 1.02/yr; 95% CI, 1.01-1.05), immune compromise (relative risk, 1.83; 95% CI, 1.40-2.40), and length of stay (relative risk, 1.03/d; 95% CI, 1.01-1.04).

Conclusions: Nearly one-quarter of children surviving hospitalization for community-acquired sepsis experienced a clinically significant deterioration in health-related quality of life. We identify risk factors for poor outcomes following sepsis and highlight the need for ongoing evaluation and treatment by primary and specialty care providers for pediatric sepsis survivors after hospital discharge.

Figure 1:

Flowchart of subjects included and excluded from analysis

Figure 2:

Distribution of PedsQL™ scores at baseline, admission, and follow-up assessments for the entire cohort and for those who failed to recover to baseline health-related quality of life. Box-plots demonstrate median and interquartile range, with whiskers representing upper and lower adjacent values (1.5x the interquartile range) and dots representing outliers.

Figure 3:

Median change in PedsQL™ by subscale for the entire cohort and stratified by those who returned to baseline health-related quality of life and those who failed to recover. Interquartile ranges are represented in parentheses.

Figure 4:

Prevalence of failure to recover to baseline HRQL as a function of time to follow-up (error bars represent 95% confidence intervals). The number of patients sampled during each follow-up time-period is indicated. Shorter time to follow-up was associated with failure to recover on bivariate (p=0.02) but not multivariable analysis.