Abstract
Background: Although some pediatric sepsis survivors experience worsening health-related quality of life (HRQL), many return to their pre-illness HRQL. Whether children can improve beyond baseline is not known. We examined a cohort of pediatric sepsis survivors to determine if those with baseline HRQL scores below the population mean could exhibit ≥10% improvement and evaluated factors associated with improvement.Methods: In this secondary analysis of the Life After Pediatric Sepsis Evaluation prospective study, children aged 1 month to 18 years admitted to 12 academic PICUs in the United States with community-acquired septic shock who survived to 3 months and had baseline HRQL scores ≤ 80 (i.e., excluding those with good baseline HRQL to allow for potential improvement) were included. HRQL was measured using the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale.Findings: One hundred and seventeen children were eligible. Sixty-one (52%) had ≥ 10% improvement in HRQL by 3 months. Lower pre-sepsis HRQL was associated with increased odds of improvement at 3 months [aOR = 1.08, 95% CI (1.04–1.11), p < 0.001] and 12 months [OR = 1.05, 95% CI (1.02–1.11), p = 0.005]. Improvement in HRQL was most prevalent at 3 month follow-up; at 12 month follow-up, improvement was more sustained among children without severe developmental delay compared to children with severe developmental delay.Interpretation: More than half of these children with community acquired septic shock experienced at least a 10% improvement in HRQL from baseline to 3 months. Children with severe developmental delay did not sustain this improvement at 12 month follow-up.
Highlights
All-cause mortality after pediatric critical illness has declined over the past 4 decades with recently reported mortality rates of 2.4% in the United States [1]
Inhospital mortality rates are 5–10% in developed nations, but the risk of morbidity and longer term mortality among survivors remain high [4]. Both clinicians and families identify survival and health related quality of life (HRQL) to be the most important outcomes after pediatric critical illness with research increasingly focusing on these patient-centered outcomes [5]
Consistent with our hypothesis, our data demonstrate that a substantial number of patients with community acquired septic shock admitted to a Pediatric Intensive Care Unit (PICU) exhibit improvement in HRQL
Summary
All-cause mortality after pediatric critical illness has declined over the past 4 decades with recently reported mortality rates of 2.4% in the United States [1]. Children who survive critical illness remain medically vulnerable with evidence of increasing rates of morbidity and mortality after discharge from the hospital through 3 year follow-up [3]. This phenomenon is apparent among the subset of critically ill children who experience sepsis In this setting, inhospital mortality rates are 5–10% in developed nations, but the risk of morbidity and longer term mortality among survivors remain high [4]. Inhospital mortality rates are 5–10% in developed nations, but the risk of morbidity and longer term mortality among survivors remain high [4] Both clinicians and families identify survival and health related quality of life (HRQL) to be the most important outcomes after pediatric critical illness with research increasingly focusing on these patient-centered outcomes [5]. We examined a cohort of pediatric sepsis survivors to determine if those with baseline HRQL scores below the population mean could exhibit ≥10% improvement and evaluated factors associated with improvement
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