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. 2024 Sep 12:46:101066.
doi: 10.1016/j.lanepe.2024.101066. eCollection 2024 Nov.

Functional dependence following intensive care unit-treated sepsis: three-year follow-up results from the prospective Mid-German Sepsis Cohort (MSC)

Carolin Fleischmann-Struzek  1   2 , Sebastian Born  1   2 , Miriam Kesselmeier  3 , E Wesley Ely  4   5 , Kristin Töpfer  2   3 , Heike Romeike  6 , Michael Bauer  2   7 , Sven Bercker  8 , Ulf Bodechtel  9 , Sandra Fiedler  10 , Heinrich V Groesdonk  11 , Sirak Petros  12 , Stefanie Platzer  2   10 , Hendrik Rüddel  2   7 , Torsten Schreiber  13 , Konrad Reinhart  14 , André Scherag  2   3
Affiliations

Functional dependence following intensive care unit-treated sepsis: three-year follow-up results from the prospective Mid-German Sepsis Cohort (MSC)

Carolin Fleischmann-Struzek et al. Lancet Reg Health Eur. .

Abstract

Background: Surviving sepsis can lead to chronic physical, psychological and cognitive impairments, which affect millions of patients worldwide, including survivors after COVID-19 viral sepsis. We aimed to characterize the magnitude and trajectory of functional dependence and new impairments post-sepsis.

Methods: We conducted a prospective cohort study including sepsis survivors who had been discharged from five German intensive care units (ICUs), until 36 months post-discharge. Primary outcome was functional dependence, defined as ≥1 impaired activity of daily living (ADL; 10-item ADL score <100), self-reported nursing care dependence or nursing care level. Secondary outcome was post-sepsis morbidity in the physical, psychological or cognitive domain. We used a multistate, competing risk model to address competing events in the course of dependence, and conducted multiple linear regression analyses to identify predictors associated with the ADL score.

Findings: Of 3210 sepsis patients screened, 1968 survived the ICU treatment (61.3%). A total of 753 were included in the follow-up assessments of the Mid-German Sepsis cohort. Patients had a median age of 65 (Q1-Q3 56-74) years, 64.8% (488/753) were male and 76.1% (573/753) had a septic shock. Considering competing risk modelling, the probability of still being functional dependent was about 25%, while about 30% regained functional independence and 45% died within the three years post-sepsis. Patients reported a high burden of new and often overlapping impairments until three years post-sepsis. In the subgroup of three-year survivors (n = 330), new physical impairments affected 91.2% (n = 301) while new cognitive and psychological impairments were reported by 57.9% (n = 191) and 40.9% (n = 135), respectively. Patients with pre-existing functional limitations and higher age were at risk for low ADL scores three years after sepsis.

Interpretation: Sepsis survivorship was associated with a broad range of new impairments and led to functional dependence in around one quarter of patients. Targeted measures are needed to mitigate the burden of this Post-Sepsis-Syndrome and increase the proportion of patients that achieve functional improvements.

Funding: This work was supported by the Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC) at the Jena University Hospital funded by the German Ministry of Education and Research and by the Rudolf Presl GmbH & Co, Kreischa, Germany.

Keywords: Functional outcome; Long-term outcome; Post-Sepsis-Syndrome; Sepsis; Sequelae.

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Conflict of interest statement

Over the past 5 years, Sven Bercker was investigator in studies sponsored by BioMeriéux, Boehringer Ingelheim, AM-Pharma B.V., Roche, Takeda, Dompé, and he is member of a DSMB for a study sponsored by hemotune AG. He has not received any personal fees for lectures or as a consultant or any reimbursement of travel expenses outside the sponsored studies. Konrad Reinhart holds shares from InflaRx NV, which is based in Jena, Germany and listed at NASDQ. This company recently received emergency use authorization by the FDA for an antibody against C5a—Gohibic (vilobelimab)—to treat critically ill COVID-19 patients, which fulfill the criteria for viral sepsis. E. Wesley Ely received NIH/VA Grant support. Over the last 36 months, the institution of Heinrich Groesdonk has received fees for his lectures, for his consultant activities, for his work in an advisory board or reimbursement for personal travel expenses by Edwards Lifescience, Amomed, and he personally holds shares from Fresenius SE. All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow of patient inclusion. Abbreviation: ICU, intensive care unit.
Fig. 2
Fig. 2
Transition probabilities three years after discharge from the intensive care unit (ICU). Results from the multistate, competing risk modelling for 753 patients (analysis set 1) of the Mid-German Sepsis Cohort with available information on their state of dependence during follow-up. Individuals were considered to be in a dependent state at the time of discharge from the ICU. Percentages in the round circles indicate the probability to remain in the respective state and percentages at arrows indicate the probability for the respective transition within the three-year time frame. Figure created with BioRender.com.
Fig. 3
Fig. 3
A: Post-Sepsis symptoms as reported by the 330 three-year survivors of the Mid-German Sepsis Cohort (MSC). Percentages indicate the proportion of individuals affected by the self-reported symptoms. Figure created with BioRender.com. B: Overlap in self-reported cognitive, psychological and physical impairments among 322 three-year survivors of the Mid-German Sepsis Cohort with complete information on all three domains. Percentages indicate the proportion of individuals affected by the self-reported impairments. Figure created with BioRender.com.
See this image and copyright information in PMC

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