Comparison of 6-month outcomes of sepsis versus non-sepsis critically ill patients receiving mechanical ventilation

Carol L Hodgson, Alisa M Higgins, Michael Bailey, Jonathon Barrett, Rinaldo Bellomo, D James Cooper, Belinda J Gabbe, Theodore Iwashyna, Natalie Linke, Paul S Myles, Michelle Paton, Steve Philpot, Mark Shulman, Meredith Young, Ary Serpa Neto, PREDICT Study Investigators, Carol L Hodgson, Alisa M Higgins, Michael Bailey, Jonathon Barrett, Rinaldo Bellomo, D James Cooper, Belinda J Gabbe, Theodore Iwashyna, Natalie Linke, Paul S Myles, Michelle Paton, Steve Philpot, Mark Shulman, Meredith Young, Ary Serpa Neto, PREDICT Study Investigators

Abstract

Background: Data on long-term outcomes after sepsis-associated critical illness have mostly come from small cohort studies, with no information about the incidence of new disability. We investigated whether sepsis-associated critical illness was independently associated with new disability at 6 months after ICU admission compared with other types of critical illness.

Methods: We conducted a secondary analysis of a multicenter, prospective cohort study in six metropolitan intensive care units in Australia. Adult patients were eligible if they had been admitted to the ICU and received more than 24 h of mechanical ventilation. There was no intervention.

Results: The primary outcome was new disability measured with the WHO Disability Assessment Schedule 2.0 (WHODAS) 12 level score compared between baseline and 6 months. Between enrollment and follow-up at 6 months, 222/888 (25%) patients died, 100 (35.5%) with sepsis and 122 (20.1%) without sepsis (P < 0.001). Among survivors, there was no difference for the incidence of new disability at 6 months with or without sepsis, 42/106 (39.6%) and 106/300 (35.3%) (RD, 0.00 (- 10.29 to 10.40), P = 0.995), respectively. In addition, there was no difference in the severity of disability, health-related quality of life, anxiety and depression, post-traumatic stress, return to work, financial distress or cognitive function.

Conclusions: Compared to mechanically ventilated patients of similar acuity and length of stay without sepsis, patients with sepsis admitted to ICU have an increased risk of death, but survivors have a similar risk of new disability at 6 months. Trial registration NCT03226912, registered July 24, 2017.

Keywords: Critical illness; Disability; Intensive care; Mechanical ventilation; Recovery; Sepsis.

Conflict of interest statement

The PREDICT Study was funded by the National Health and Medical Research Council of Australia (GNT1132976). Professor Hodgson is supported by a National Health and Medical Research Council Investigator Grant (GNT1173271). Professor Gabbe is supported by an Australian Research Council Future Fellowship (FT170100048). Professors Cooper, Myles and Bellomo were all supported by NHMRC Practitioner Fellowships. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Dr Serpa Neto reported personal fees from Drager outside the submitted work. All other authors have disclosed that they do not have any potential conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Kaplan–Meier curve of 6-month survival in patients with sepsis (red) and without sepsis (blue)
Fig. 2
Fig. 2
Trajectory of outcomes to 6 months in patients with sepsis (red) and without sepsis (blue). A–C Circles are mean and error bars are 95% confidence interval. P values calculated from the interaction between sepsis and time from a mixed-effect generalized linear model with Gaussian distribution, including center as random effect, and adjusted by age, sex, ICU admission source, APACHE III score, type of admission (medical vs. surgical), lung transplant patients, trauma, creatinine, heart rate, mean arterial pressure, presence of chronic cardiovascular disease and ICU length of stay. Models were further adjusted by the baseline value of the outcome of interest as fixed effect. D Outcomes assessed at 6 months of follow-up. Boxes represent median and interquartile range. Whiskers extend 1.5 times the interquartile range beyond the first and third quartiles per the conventional Tukey method. Transparent circles beyond the whiskers represent outliers. Abbreviations: WHODAS, WHO Disability Assessment Schedule 2.0; IES-R, Impact of Event Scale–Revised; IADL, instrumental activities of daily living; and MoCA-BLIND, Montreal Cognitive Assessment
Fig. 3
Fig. 3
New disability at 3 and 6 months in patients with sepsis (red) and without sepsis (blue)

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