Epidemiology and long-term outcome after severe symmetric peripheral gangrene

Abstract

Symmetric peripheral gangrene (SPG) is a rare but severe complication of septic shock often leading to multiple amputations. Epidemiology of SPG and long-term outcome remain poorly known. Amputations are serious offense to body but can benefit from rehabilitation and prosthesis. Our objectives were to describe epidemiology of SPG and to assess health-related quality of life (HRQOL) once rehabilitation was achieved. A prospective and retrospective, multicentric study was performed. Adult patients hospitalised between 2005 and 2015 were included. They must have undergone at least two amputations (whatever the level) and have been discharged in a specialized rehabilitation Department. HRQOL was assessed with generic scale EQ-5D-3L by phone call. Epidemiologic data were extracted from medical letters. Nine centres on 13 participated, 32 patients were recruited and medical letters were available for 27 of them. SPG was observed in a majority of female (59%), aged around 53 yo. Mean intensive care unit (ICU) length of stay was 39 (±22) days. Infectious agents were in majority Gram positive or negative cocci (68%), but Escherichia Coli took an important part (17%). All patients were amputated of the two lower limbs and 84% were quadruple amputees. HRQOL estimated with EQ index was inferior to the French reference. However, patients rated themselves their health state as similar to the reference and superior to the reference before SPG. Intense pain due to phantom pain was the main factor of impaired EQ index. Painkillers use was statistically dependant of antidepressants use. All patient, except one, said they would be willing to be treated again for SPG. SPG is mainly due to Gram positive or negative cocci but also Escherichia Coli and leads to severe amputations with impaired HRQOL. This is in line with the literature. However, patients report being in good health, but in excellent health before SPG. Such important decrease after sudden critical illness was observed in major trauma. A better analgesic strategy may improve HRQOL. Nevertheless, patients would be willing to be treated again. This should be taken into account before withdrawing life-sustaining therapies.