Health-related Outcomes of Critically Ill Patients with and Without Sepsis

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2018 Jun 29

PMID 29951846

Citations 22

Authors

Kelly Thompson

Colman Taylor

Stephen Jan

Qiang Li

Naomi Hammond

John Myburgh

Manoj Saxena

Balasubramanian Venkatesh

Simon Finfer

Affiliations

Soon will be listed here.

Abstract

Purpose: To determine differences in health-related quality of life (HRQoL), survival and healthcare resource use of critically ill adults with and without sepsis.

Methods: We conducted a primary propensity score matched analysis of patients with and without sepsis enrolled in a large multicentre clinical trial. Outcomes included HRQoL at 6 months, survival to 2 years, length of ICU and hospital admission and cost of ICU and hospital treatment to 2 years.

Results: We obtained linked data for 3442 (97.3%) of 3537 eligible patients and matched 806/905 (89.0%) patients with sepsis with 806/2537 (31.7%) without. After matching, there were no significant differences in the proportion of survivors with and without sepsis reporting problems with mobility (37.8% vs. 38.7%, p = 0.86), self-care (24.7% vs. 26.0%, p = 0.44), usual activities (44.5% vs. 46.8%, p = 0.28), pain/discomfort (42.4% vs. 41.6%, p = 0.54) and anxiety/depression (36.9% vs. 37.7%, p = 0.68). There was no significant difference in survival at 2 years: 482/792 (60.9%) vs. 485/799 (60.7%) (HR 1.01, 95% CI 0.86-1.18, p = 0.94). The initial ICU and hospital admission were longer for patients with sepsis: 10.1 ± 11.9 vs. 8.0 ± 9.8 days (p < 0.0001) and 22.8 ± 21.2 vs. 19.1 ± 19.0 days, (p = 0.0003) respectively. The cost of ICU admissions was higher for patients with sepsis: A$43,345 ± 46,263 (€35,109 ± 35,043) versus 34,844 ± 38,281 (€28,223 ± 31,007), mean difference $8501 (€6885), 95% CI $4342-12,660 (€3517 ± 10,254), p < 0.001 as was the total cost of hospital treatment to 2 years: A$74,120 ± 60,750 (€60,037 ± 49,207) versus A$65,806 ± 59,856 (€53,302 ± 48,483), p = 0.005.

Conclusions: Critically ill patients with sepsis have higher healthcare resource use and costs but similar survival and HRQoL compared to matched patients without sepsis.

Citing Articles

Three-year mortality of ICU survivors with sepsis, an infection or an inflammatory illness: an individually matched cohort study of ICU patients in the Netherlands from 2007 to 2019.

Arbous S, Termorshuizen F, Brinkman S, de Lange D, Bosman R, Dekkers O Crit Care. 2024; 28(1):374.

PMID: 39563453 PMC: 11577713. DOI: 10.1186/s13054-024-05165-x.

Post-discharge functional outcomes in older patients with sepsis.

Ge S, Zha L, Tanaka A, Narii N, Shimomura Y, Komatsu M Crit Care. 2024; 28(1):281.

PMID: 39210369 PMC: 11363546. DOI: 10.1186/s13054-024-05080-1.

What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis.

Yarnell C, Barrett K, Heath A, Herridge M, Fowler R, Sung L Crit Care Explor. 2024; 6(6):e1098.

PMID: 38836575 PMC: 11152783. DOI: 10.1097/CCE.0000000000001098.

PAMPs and DAMPs in Sepsis: A Review of Their Molecular Features and Potential Clinical Implications.

Cicchinelli S, Pignataro G, Gemma S, Piccioni A, Picozzi D, Ojetti V Int J Mol Sci. 2024; 25(2).

PMID: 38256033 PMC: 10815927. DOI: 10.3390/ijms25020962.

Outcomes following severe septic shock in a cohort of Aboriginal and Torres Strait Islander people: a nested cohort study from the ADRENAL trial.

Donaldson L, Hammond N, Agarwal S, Taylor S, Bompoint S, Coombes J Crit Care Resusc. 2023; 24(1):20-28.

PMID: 38046842 PMC: 10692597. DOI: 10.51893/2022.1.OA3.

References

Desai S, Law T, Needham D . Long-term complications of critical care. Crit Care Med. 2010; 39(2):371-9. DOI: 10.1097/CCM.0b013e3181fd66e5. View

Myburgh J, Finfer S, Bellomo R, Billot L, Cass A, Gattas D . Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012; 367(20):1901-11. DOI: 10.1056/NEJMoa1209759. View

Cohen J, Guyatt G, Bernard G, Calandra T, Cook D, Elbourne D . New strategies for clinical trials in patients with sepsis and septic shock. Crit Care Med. 2001; 29(4):880-6. DOI: 10.1097/00003246-200104000-00039. View

Ghelani D, Moran J, Sloggett A, Leeson R, Peake S . Long-term survival of intensive care and hospital patient cohorts compared with the general Australian population: a relative survival approach. J Eval Clin Pract. 2009; 15(3):425-35. DOI: 10.1111/j.1365-2753.2008.01030.x. View

Iwashyna T, Wesley Ely E, Smith D, Langa K . Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010; 304(16):1787-94. PMC: 3345288. DOI: 10.1001/jama.2010.1553. View

Shankar-Hari M, Ambler M, Mahalingasivam V, Jones A, Rowan K, Rubenfeld G . Evidence for a causal link between sepsis and long-term mortality: a systematic review of epidemiologic studies. Crit Care. 2016; 20:101. PMC: 4831092. DOI: 10.1186/s13054-016-1276-7. View

Liu V, Escobar G, Greene J, Soule J, Whippy A, Angus D . Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014; 312(1):90-2. DOI: 10.1001/jama.2014.5804. View

Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J . Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med. 2004; 30(4):589-96. DOI: 10.1007/s00134-004-2157-0. View

Cohen J, Vincent J, Adhikari N, Machado F, Angus D, Calandra T . Sepsis: a roadmap for future research. Lancet Infect Dis. 2015; 15(5):581-614. DOI: 10.1016/S1473-3099(15)70112-X. View

10.

. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16(3):199-208. DOI: 10.1016/0168-8510(90)90421-9. View

11.

Elliott D, Davidson J, Harvey M, Bemis-Dougherty A, Hopkins R, Iwashyna T . Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting. Crit Care Med. 2014; 42(12):2518-26. DOI: 10.1097/CCM.0000000000000525. View

12.

Prescott H, Langa K, Liu V, Escobar G, Iwashyna T . Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med. 2014; 190(1):62-9. PMC: 4226030. DOI: 10.1164/rccm.201403-0471OC. View

13.

Davis J, He V, Anstey N, Condon J . Long term outcomes following hospital admission for sepsis using relative survival analysis: a prospective cohort study of 1,092 patients with 5 year follow up. PLoS One. 2014; 9(12):e112224. PMC: 4259299. DOI: 10.1371/journal.pone.0112224. View

14.

Prescott H, Costa D . Improving Long-Term Outcomes After Sepsis. Crit Care Clin. 2017; 34(1):175-188. PMC: 5708876. DOI: 10.1016/j.ccc.2017.08.013. View

15.

Garrido M, Kelley A, Paris J, Roza K, Meier D, Morrison R . Methods for constructing and assessing propensity scores. Health Serv Res. 2014; 49(5):1701-20. PMC: 4213057. DOI: 10.1111/1475-6773.12182. View

16.

Bone R, Balk R, Cerra F, Dellinger R, Fein A, Knaus W . Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101(6):1644-55. DOI: 10.1378/chest.101.6.1644. View

17.

Fleischmann C, Thomas-Rueddel D, Hartmann M, Hartog C, Welte T, Heublein S . Hospital Incidence and Mortality Rates of Sepsis. Dtsch Arztebl Int. 2016; 113(10):159-66. PMC: 4814768. DOI: 10.3238/arztebl.2016.0159. View

18.

Taylor C, Thompson K, Finfer S, Higgins A, Jan S, Li Q . Hydroxyethyl starch versus saline for resuscitation of patients in intensive care: long-term outcomes and cost-effectiveness analysis of a cohort from CHEST. Lancet Respir Med. 2016; 4(10):818-825. DOI: 10.1016/S2213-2600(16)30120-5. View

19.

Austin P . An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav Res. 2011; 46(3):399-424. PMC: 3144483. DOI: 10.1080/00273171.2011.568786. View

20.

Patel A, Pieper K, Myburgh J, Perkovic V, Finfer S, Yang Q . Reanalysis of the Crystalloid versus Hydroxyethyl Starch Trial (CHEST). N Engl J Med. 2017; 377(3):298-300. DOI: 10.1056/NEJMc1703337. View