• Anna K Gardner, Gabriela L Ghita, Zhongkai Wang, Tezcan Ozrazgat-Baslanti, Steven L Raymond, Robert T Mankowski, Babette A Brumback, Philip A Efron, Azra Bihorac, Frederick A Moore, Stephen D Anton, and Scott C Brakenridge.
• Department of Surgery, University of Florida, Gainesville, FL.
• Crit. Care Med. 2019 Apr 1; 47 (4): 566-573.

ObjectivesThis study sought to examine mortality, health-related quality of life, and physical function among sepsis survivors who developed chronic critical illness.DesignSingle-institution, prospective, longitudinal, observational cohort study assessing 12-month outcomes.SettingTwo surgical/trauma ICUs at an academic tertiary medical and level 1 trauma center.PatientsAdult critically ill patients that survived 14 days or longer after sepsis onset.InterventionsNone.Measurements And Main ResultsBaseline patient characteristics and function, sepsis severity, and clinical outcomes of the index hospitalization were collected. Follow-up physical function (short physical performance battery; Zubrod; hand grip strength) and health-related quality of life (EuroQol-5D-3L, Short Form-36) were measured at 3, 6, and 12 months. Hospital-free days and mortality were determined at 12 months. We compared differences in long-term outcomes between subjects who developed chronic critical illness (≥ 14 ICU days with persistent organ dysfunction) versus those with rapid recovery. The cohort consisted of 173 sepsis patients; 63 (36%) developed chronic critical illness and 110 (64%) exhibited rapid recovery. Baseline physical function and health-related quality of life did not differ between groups. Those who developed chronic critical illness had significantly fewer hospital-free days (196 ± 148 vs 321 ± 65; p < 0.0001) and reduced survival at 12-months compared with rapid recovery subjects (54% vs 92%; p < 0.0001). At 3- and 6-month follow-up, chronic critical illness patients had significantly lower physical function (3 mo: short physical performance battery, Zubrod, and hand grip; 6 mo: short physical performance battery, Zubrod) and health-related quality of life (3- and 6-mo: EuroQol-5D-3L) compared with patients who rapidly recovered. By 12-month follow-up, chronic critical illness patients had significantly lower physical function and health-related quality of life on all measures.ConclusionsSurgical patients who develop chronic critical illness after sepsis exhibit high healthcare resource utilization and ultimately suffer dismal long-term clinical, functional, and health-related quality of life outcomes. Further understanding of the mechanisms driving the development and persistence of chronic critical illness will be necessary to improve long-term outcomes after sepsis.

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