The association between a sepsis diagnosis, demographic factors, and health-related quality of life in survivors at 180 days following critical illness.

Abstract / Summary

Survivors of critical illness often have poor health-related quality of life (HRQoL). However, it is unclear what factors are associated with changes in HRQoL after critical illness. The aim of this study was to determine an association between sepsis diagnosis, demographic factors (age and sex), and HRQoL in survivors following critical illness. A secondary analysis of international data from the previously published Standard Issue Transfusion versus Fresher Red Blood Cell Use in Intensive Care (TRANSFUSE Study) Randomised Controlled Trial, an international, multicentre randomised double-blind trial, was conducted. Adult patients admitted to the intensive care unit undergoing transfusion of one or more red blood cell units were included. HRQoL was measured using the EuroQol five-dimension three-level instrument at 180 days post randomisation. Estimates for the EuroQol five-dimension utility value and EuroQol visual analogue scale (EQ VAS) were reported as median difference with 95% confidence intervals. Among 4919 participants, 3459 survived to 180 days, of which 3143 (91%) had complete HRQoL data. There were no significant differences in the utility value and EQ VAS between survivors following critical illness with and without sepsis (utility value difference: -0.02 [-0.04 to 0.00], p = 0.11; EQ VAS difference: -1.17 [-4.35 to 2.02], p = 0.47) or between male and female survivors (utility value difference: -0.01 [-0.03 to 0.01], p = 0.34; EQ VAS difference: -0.94 [-3.06 to 1.18], p = 0.38). Patients aged 50-59 years (-0.07 [-0.12 to -0.03], p = 0.002), 60-69 years (-0.05 [-0.10 to -0.01], p = 0.016), and ≥80 years (-0.07 [-0.12 to -0.02], p = 0.003) had a significantly lower utility value than patients aged 18-29 years. Patients aged 50-59 years (-7.35 [-11.97 to -2.73], p = 0.002), 60-69 years (-6.10 [-11.00 to -1.19], p = 0.015), and ≥80 years (-6.78 [-12.04 to -1.53], p = 0.011) also had a lower EQ VAS score than patients aged 18-29 years. After adjustment for age, comorbidities, and illness severity, sepsis diagnosis was not independently associated with lower HRQoL at 180 days. These findings are consistent with emerging evidence suggesting that long-term outcomes in intensive care unit survivors may be driven predominantly by critical illness rather than aetiology. No significant differences in the utility value or EQ VAS were found by sex. However, there were significant differences in HRQoL by age in survivors following critical illness.

Related Clinical Guidelines