Effects of Sepsis on Morbidity and Mortality in Critically Ill Patients 2 Years After Intensive Care Unit Discharge

Livia Biason, MD; Cassiano Teixeira, MD, PhD; Jaqueline Sangiogo Haas, RN, MS; Cláudia da Rocha Cabral, RN; Gilberto Friedman, MD, PhD

Disclosures

Am J Crit Care. 2019;28(6):424-432. 

In This Article

Abstract and Introduction

Abstract

Background: Morbidity and mortality after discharge from an intensive care unit appear to be higher in patients with sepsis than in patients without sepsis.

Objective: To evaluate morbidity and mortality in patients with and without sepsis within 2 years after intensive care unit discharge.

Methods: A prospective cohort study was conducted in 2 intensive care units. Patients who stayed in the intensive care unit longer than 24 hours were followed up for 2 years after discharge. Morbidity was assessed by using the Karnofsky scale, the Lawton instrumental activities of daily living scale, presence of pain, and readmissions.

Results: During the study, 74.7% of patients (859 of 1150; 242 with sepsis, 617 without sepsis) were discharged from the intensive care unit. Compared with patients without sepsis, patients with sepsis had higher mortality during follow-up (57.4% vs 34.2%; P < .001) and were 1.34 times as likely to die (per Cox regression). More patients with sepsis had pain (48.5% vs 35.2%, P = .003) and read-missions (65.5% vs 55.0%, P = .02). Patients with sepsis had a greater degree of functional loss, adjusted for confounding factors (mean SD change in Lawton scale score from intensive care unit admission to 2 years after intensive care unit discharge, 4.0 [8.0] vs 3.4 [8.2]; P = .31).

Conclusion: Compared with patients without sepsis, those with sepsis have higher mortality in the intensive care unit and have more pain, hospital readmissions, and functional decline within 2 years after discharge.

Introduction

Sepsis is a frequent cause of admission to intensive care units (ICUs) and is associated with a high mortality rate and increased health care costs during the ICU stay.[1,2] After ICU discharge, patients with sepsis have a high mortality rate,[3–5] from 30% to 45% within the first year[5,6] and reaching 50% at 2 years.[7] These patients, when compared with critically ill patients without sepsis, appear to have higher long-term mortality rates.[4,8]

Studies of long-term morbidity are heterogeneous but patients with sepsis have greater functional decline than patients without sepsis,[3,5,9] comparable to that seen in patients with chronic diseases.[10] Within 6 months of ICU discharge, partial functional recovery appears to occur, although a return to pre-ICU status is uncommon.[6,11]

Few studies of the incidence and mortality of sepsis in developing countries have been conducted.[12,13] Short-term mortality in ICU patients with sepsis is consistently higher in developing countries than in developed countries.[1,14] However, the actual mortality rate and functional decline that these patients experience after discharge in developing countries remain unclear. We hypothesized that patients with sepsis would have greater long-term mortality and functional decline than would critically ill patients without sepsis. We therefore designed this study to evaluate morbidity and mortality in critically ill patients with sepsis versus those without sepsis within 2 years of ICU discharge.

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