Mortality and quality of life in the five years after severe sepsis

Brian H Cuthbertson, Andrew Elders, Sally Hall, Jane Taylor, Graeme MacLennan, Fiona Mackirdy, Simon J Mackenzie, Scottish Critical Care Trials Group, Scottish Intensive Care Society Audit Group, Brian Cuthbertson, Brian H Cuthbertson, Andrew Elders, Sally Hall, Jane Taylor, Graeme MacLennan, Fiona Mackirdy, Simon J Mackenzie, Scottish Critical Care Trials Group, Scottish Intensive Care Society Audit Group, Brian Cuthbertson

Abstract

Introduction: Severe sepsis is associated with high levels of morbidity and mortality, placing a high burden on healthcare resources. We aimed to study outcomes in the five years after severe sepsis.

Methods: This was a cohort study using data from a prospective audit in 26 adult ICUs in Scotland. Mortality was measured using clinical databases and quality of life using Short Form 36 (SF-36) at 3.5 and 5 years after severe sepsis.

Results: A total of 439 patients were recruited with a 58% mortality at 3.5 years and 61% mortality at 5 years. A total of 85 and 67 patients responded at 3.5 and 5 years follow-up, respectively. SF-36 physical component score (PCS) was low compared to population controls at 3.5 years (mean 41.8 (SD 11.8)) and at 5 years (mean 44.8 (SD 12.7)). SF-36 mental component score (MCS) was slightly lower than population controls at 3.5 years (mean 47.7 (SD 14.6)) and at 5 years after severe sepsis (mean 48.8 (SD 12.6)). The majority of patients were satisfied with their current quality of life (QOL) (80%) and all patients would be willing to be treated in an ICU again if they become critically ill despite many having unpleasant memories (19%) and recall (29%) of ICU events.

Conclusions: Patients with severe sepsis have a high ongoing mortality after severe sepsis. They also have a significantly lower physical QOL compared to population norms but mental QOL scores were only slightly below population norms up to five years after severe sepsis. All survivors would be willing to be treated in an ICU again if critically ill. Mortality and QOL outcomes were broadly similar to other critically ill cohorts throughout the five years of follow-up.

Figures

Figure 1
Figure 1
Participant flow diagram.
Figure 2
Figure 2
Kaplan-Meier survival estimates for the entire cohort.

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