Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock

Abstract

Objectives: In-hospital pediatric sepsis mortality has decreased substantially, but long-term mortality and morbidity among children initially surviving sepsis, is unknown. Accordingly, the Life After Pediatric Sepsis Evaluation investigation was conducted to describe the trajectory of mortality and health-related quality of life morbidity for children encountering community-acquired septic shock.

Design: Prospective, cohort-outcome study, conducted 2013-2017.

Setting: Twelve academic PICUs in the United States.

Patients: Critically ill children, 1 month to 18 years, with community-acquired septic shock requiring vasoactive-inotropic support.

Interventions: Demographic, infection, illness severity, organ dysfunction, and resource utilization data were collected daily during PICU admission. Serial parent proxy-report health-related quality of life assessments were obtained at baseline, 7 days, and 1, 3, 6, and 12 months following PICU admission utilizing the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale.

Measurements and main results: Among 389 children enrolled, mean age was 7.4 ± 5.8 years; 46% were female; 18% were immunocompromised; and 51% demonstrated chronic comorbidities. Baseline Pediatric Overall Performance Category was normal in 38%. Median (Q1-Q3) Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores at PICU admission were 11.0 (6.0-17.0) and 9.0 (6.0-11.0); durations of vasoactive-inotropic and mechanical ventilation support were 3.0 days (2.0-6.0 d) and 8.0 days (5.0-14.0 d); and durations of PICU and hospital stay were 9.4 days (5.6-15.4 d) and 15.7 days (9.2-26.0 d). At 1, 3, 6, and 12 months following PICU admission for the septic shock event, 8%, 11%, 12%, and 13% of patients had died, while 50%, 37%, 30%, and 35% of surviving patients had not regained their baseline health-related quality of life.

Conclusions: This investigation provides the first longitudinal description of long-term mortality and clinically relevant, health-related quality of life morbidity among children encountering community-acquired septic shock. Although in-hospital mortality was 9%, 35% of survivors demonstrated significant, health-related quality of life deterioration from baseline that persisted at least 1 year following hospitalization for septic shock.

Figures

Figure 1.

LAPSE Consort Diagram

Figure 2.

Distributions of Pediatric Cerebral Performance Category and Pediatric Overall Performance Category Scores Over Time. Abbreviations: PCPC, Pediatric Cerebral Performance Category; POPC, Pediatric Overall Performance Category; Baseline, status in the month preceding PICU admission for the sepsis event; Discharge, assessment at Day 28 or Hospital Discharge, which ever occurred first.

Figure 3.

Distribution of Functional Status Scale (FSS) Categories Over Time Baseline, status in the month preceding PICU admission for the sepsis event; Discharge, assessment at Day 28 or Hospital Discharge, which ever occurred first.

Figure 4.

Longitudinal Assessment of Failure to Return to Baseline Health-related Quality of Life Utilizing the PedsQL™ (Figure 4A) and FS-IIR (Figure 4B) Instruments. Magnitude of HRQL deterioration is depicted in in multiples of 4.5 points, namely 4.5, 9.0, 13.5, and 18.0 points

Figure 4.

Longitudinal Assessment of Failure to Return to Baseline Health-related Quality of Life Utilizing the PedsQL™ (Figure 4A) and FS-IIR (Figure 4B) Instruments. Magnitude of HRQL deterioration is depicted in in multiples of 4.5 points, namely 4.5, 9.0, 13.5, and 18.0 points