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Intensive Care Medicine

, Volume 44, Issue 8, pp 1249–1257 | Cite as

Health-related outcomes of critically ill patients with and without sepsis

  • Kelly Thompson
  • Colman Taylor
  • Stephen Jan
  • Qiang Li
  • Naomi Hammond
  • John Myburgh
  • Manoj Saxena
  • Balasubramanian Venkatesh
  • Simon Finfer
Original

Abstract

Purpose

To determine differences in health-related quality of life (HRQoL), survival and healthcare resource use of critically ill adults with and without sepsis.

Methods

We conducted a primary propensity score matched analysis of patients with and without sepsis enrolled in a large multicentre clinical trial. Outcomes included HRQoL at 6 months, survival to 2 years, length of ICU and hospital admission and cost of ICU and hospital treatment to 2 years.

Results

We obtained linked data for 3442 (97.3%) of 3537 eligible patients and matched 806/905 (89.0%) patients with sepsis with 806/2537 (31.7%) without. After matching, there were no significant differences in the proportion of survivors with and without sepsis reporting problems with mobility (37.8% vs. 38.7%, p = 0.86), self-care (24.7% vs. 26.0%, p = 0.44), usual activities (44.5% vs. 46.8%, p = 0.28), pain/discomfort (42.4% vs. 41.6%, p = 0.54) and anxiety/depression (36.9% vs. 37.7%, p = 0.68). There was no significant difference in survival at 2 years: 482/792 (60.9%) vs. 485/799 (60.7%) (HR 1.01, 95% CI 0.86–1.18, p = 0.94). The initial ICU and hospital admission were longer for patients with sepsis: 10.1 ± 11.9 vs. 8.0 ± 9.8 days (p < 0.0001) and 22.8 ± 21.2 vs. 19.1 ± 19.0 days, (p = 0.0003) respectively. The cost of ICU admissions was higher for patients with sepsis: A$43,345 ± 46,263 (€35,109 ± 35,043) versus 34,844 ± 38,281 (€28,223 ± 31,007), mean difference $8501 (€6885), 95% CI $4342–12,660 (€3517 ± 10,254), p < 0.001 as was the total cost of hospital treatment to 2 years: A$74,120 ± 60,750 (€60,037 ± 49,207) versus A$65,806 ± 59,856 (€53,302 ± 48,483), p = 0.005.

Conclusions

Critically ill patients with sepsis have higher healthcare resource use and costs but similar survival and HRQoL compared to matched patients without sepsis.

Keywords

Sepsis Post-sepsis syndrome Post-intensive care syndrome Long-term outcomes 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare no conflicts of interest.

Supplementary material

134_2018_5274_MOESM1_ESM.docx (255 kb)
Supplementary material 1 (DOCX 254 kb)

References

  1. 1.
    Torio C, Moore, BJ (2016) National inpatient hospital costs: the most expensive conditions by payer, 2013. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-Most-Expensive-Hospital-Conditions.jsp. Accessed 12 Dec 2017
  2. 2.
    Seventieth World Health Assembly (2017) Improving the prevention, diagnosis and clinical management of sepsis. http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_R7-en.pdf. Accessed 12 Dec 2017
  3. 3.
    Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC et al (2014) Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 312(1):90–92CrossRefPubMedGoogle Scholar
  4. 4.
    Fleischmann C, Thomas-Rueddel DO, Hartmann M, Hartog CS, Welte T, Heublein S et al (2016) Hospital incidence and mortality rates of sepsis. Dtsch Arzteblatt Int 113(10):159–166Google Scholar
  5. 5.
    Cohen J, Vincent JL, Adhikari NK, Machado FR, Angus DC, Calandra T et al (2015) Sepsis: a roadmap for future research. Lancet Infect Dis 15(5):581–614CrossRefPubMedGoogle Scholar
  6. 6.
    Zimmerman JE, Kramer AA, Knaus WA (2013) Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 17(2):R81CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Desai SV, Law TJ, Needham DM (2011) Long-term complications of critical care. Crit Care Med 39(2):371–379CrossRefPubMedGoogle Scholar
  8. 8.
    Yende S, Austin S, Rhodes A, Finfer S, Opal S, Thompson T et al (2016) Long-term quality of life among survivors of severe sepsis: analyses of two international trials. Crit Care Med 44(8):1461–1467CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Prescott HC, Costa DK (2018) Improving long-term outcomes after sepsis. Crit Care Clin 34(1):175–188CrossRefPubMedGoogle Scholar
  10. 10.
    Elliott D, Davidson JE, Harvey MA, Bemis-Dougherty A, Hopkins RO, Iwashyna TJ et al (2014) Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting. Crit Care Med 42(12):2518–2526CrossRefPubMedGoogle Scholar
  11. 11.
    Shankar-Hari M, Ambler M, Mahalingasivam V, Jones A, Rowan K, Rubenfeld GD (2016) Evidence for a causal link between sepsis and long-term mortality: a systematic review of epidemiologic studies. Crit Care 20:101CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D et al (2012) Hydroxyethyl starch or saline for fluid resuscitation in intensive care. New Engl J Med 367(20):1901–1911CrossRefPubMedGoogle Scholar
  13. 13.
    Patel A, Pieper K, Myburgh JA, Perkovic V, Finfer S, Yang Q et al (2017) Reanalysis of the crystalloid versus hydroxyethyl starch trial (CHEST). New Engl J Med 377(3):298–300CrossRefPubMedGoogle Scholar
  14. 14.
    Taylor C, Thompson K, Finfer S, Higgins A, Jan S, Li Q et al (2016) Hydroxyethyl starch versus saline for resuscitation of patients in intensive care: long-term outcomes and cost-effectiveness analysis of a cohort from CHEST. Lancet Respir Med 4(10):818–825CrossRefPubMedGoogle Scholar
  15. 15.
    Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424CrossRefGoogle Scholar
  16. 16.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829CrossRefPubMedGoogle Scholar
  17. 17.
    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA et al (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101(6):1644–1655CrossRefPubMedGoogle Scholar
  18. 18.
    Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315(8):801–810CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    EuroQol G (1990) EuroQol–a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208CrossRefGoogle Scholar
  20. 20.
    Inter-Government and Funding Strategies (2011) Costs of care standards 2009/10. http://www1.health.nsw.gov.au/pds/ArchivePDSDocuments/GL2011_007.pdf. Accessed Dec 2016
  21. 21.
    Australian Government Department of Health (2012) Round 14 (2009–2010) National public cost weight tables—version 6.0x and version 5.2. http://www.health.gov.au/internet/main/publishing.nsf/Content/Round_14-cost-reports. Accessed 12 Dec 2017
  22. 22.
    Garrido MM, Kelley AS, Paris J, Roza K, Meier DE, Morrison RS et al (2014) Methods for constructing and assessing propensity scores. Health Serv Res 49(5):1701–1720CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Funk MJ, Westreich D, Wiesen C, Sturmer T, Brookhart MA, Davidian M (2011) Doubly robust estimation of causal effects. Am J Epidemiol 173(7):761–767CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ (2016) Late mortality after sepsis: propensity matched cohort study. BMJ 353:i2375CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Prescott HC, Langa KM, Liu V, Escobar GJ, Iwashyna TJ (2014) Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med 190(1):62–69CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ghelani D, Moran JL, Sloggett A, Leeson RJ, Peake SL (2009) Long-term survival of intensive care and hospital patient cohorts compared with the general Australian population: a relative survival approach. J Eval Clin Pract 15(3):425–435CrossRefPubMedGoogle Scholar
  27. 27.
    Davis JS, He V, Anstey NM, Condon JR (2014) Long term outcomes following hospital admission for sepsis using relative survival analysis: a prospective cohort study of 1,092 patients with 5 year follow up. PLoS One 9(12):e112224CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Iwashyna TJ, Ely EW, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304(16):1787–1794CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hofhuis JG, Spronk PE, van Stel HF, Schrijvers AJ, Rommes JH, Bakker J (2008) The impact of severe sepsis on health-related quality of life: a long-term follow-up study. Anesth Analg 107(6):1957–1964CrossRefPubMedGoogle Scholar
  30. 30.
    Battle CE, Davies G, Evans PA (2014) Long term health-related quality of life in survivors of sepsis in South West Wales: an epidemiological study. PLoS One 9(12):e116304CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J et al (2004) Adult population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med 30:589–596CrossRefPubMedGoogle Scholar
  32. 32.
    Cohen J, Guyatt G, Bernard GR, Calandra T, Cook D, Elbourne D et al (2001) New strategies for clinical trials in patients with sepsis and septic shock. Crit Care Med 29(4):880–886CrossRefPubMedGoogle Scholar
  33. 33.
    Angus DC (2010) The lingering consequences of sepsis: a hidden public health disaster? JAMA 304(16):1833–1834CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Kelly Thompson
    • 1
    • 2
  • Colman Taylor
    • 1
    • 2
  • Stephen Jan
    • 1
    • 2
  • Qiang Li
    • 1
  • Naomi Hammond
    • 1
    • 2
    • 3
    • 4
  • John Myburgh
    • 1
    • 2
    • 5
  • Manoj Saxena
    • 1
    • 2
    • 5
  • Balasubramanian Venkatesh
    • 1
    • 2
    • 6
    • 7
  • Simon Finfer
    • 1
    • 2
    • 3
    • 4
  1. 1.The George Institute for Global HealthSydneyAustralia
  2. 2.University of New South WalesSydneyAustralia
  3. 3.Sydney Medical SchoolUniversity of SydneySydneyAustralia
  4. 4.Malcolm Fisher Department of Intensive Care MedicineRoyal North Shore HospitalSydneyAustralia
  5. 5.St George Clinical SchoolUniversity of New South WalesSydneyAustralia
  6. 6.The Princess Alexandra HospitalUniversity of QueenslandBrisbaneAustralia
  7. 7.The Wesley HospitalBrisbaneAustralia

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