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Sepsis survivors face significant impairments requiring long-term care strategies

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January 11, 2018

A recently published review found that despite improvements in sepsis survival rates, survivors often experience a host of physical and mental health problems.

Researchers recommended monitoring patients for new physical, cognitive or mental problems, reviewing and adjusting long-term medications and evaluating patients for treatable conditions that could result in hospital readmission.

“Current treatment guidelines emphasize interventions that reduce short-term mortality, but with little information on strategies to minimize physical disability, cognitive impairment or health deterioration after sepsis,” Derek Angus, MD, MPH, professor and chair of the department of critical care medicine at the University of Pittsburgh, said in a press release. “We need to focus not only on saving the patient’s life, but on ensuring the patient will have the best possible quality of life after leaving the hospital.”

Angus and co-author Hallie C. Prescott, MD, MSc, assistant professor at the University of Michigan, searched MEDLINE and PubMED from Jan. 1, 2000, through April 26, 2017, to review studies that focused on patients who had survived sepsis.

Of a total 19.4 million patients who developed sepsis each year, 14.1 million survive long enough to be discharged from the hospital, the researchers reported. Of those who survived sepsis, one-third died the following year, and one-sixth experienced disabilities or cognitive impairments following treatment.

Patients with impairments had a mean of one to two new limitations in how they functioned, such as the inability to dress themselves or breathe independently, Angus and Prescott reported. Patients also had nearly a threefold greater prevalence of cognitive impairment following hospitalization (16.7% after hospitalization vs. 6.1% before hospitalization). Roughly one-third of survivors experienced depression (29%) or anxiety (32%), whereas nearly half (44%) experienced PTSD, the researchers wrote.

Further, 40% of patients were readmitted to the hospital within 90 days of being discharged, according to Prescott and Angus. These patients were frequently admitted with conditions that could be treated in an outpatient setting, including exacerbation of heart failure (5.5%) and infection (11.9%).

Sepsis survivors were at significantly increased risk for recurrent infection compared with control patients, the researchers wrote (11.9% vs. 8%; P < .001), as well as increased risk for acute renal failure (3.3% vs. 1.2%; P < .001) and new cardiovascular events (adjusted HR range, 1.1-1.4).

Angus and Prescott recommended that to prevent long-term disabilities, physicians should ensure high-quality early sepsis care; provide assessment and treatment after discharge from the hospital to ensure that patients receive physical, occupational or speech therapy with quick referral in case of new impairments; and screen patients for health conditions that may have already been present before the patient was hospitalized.

“While we are making these recommendations based on available research, many important questions about post-sepsis morbidity remain unanswered,” Prescott said in the press release. “Future research is needed to better characterize how pre-sepsis health affects long-term outcomes after sepsis so we can best tailor treatment and long-term recovery to the patient.” – by Andy Polhamus

Disclosures: Angus reports a consulting role with Ferrin Pharmaceuticals. Prescott reports receiving grants from NIH and serving on the advisory board of a Bristol-Myers Squibb-supported study.

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