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One in four children have decreased quality of life after sepsis
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Almost one-quarter of children who survived community-acquired sepsis experienced significant declines in health-related quality of life, lasting up to 4.5 months after discharge, according to research presented at the Pediatric Academic Societies Meeting.
“We are just beginning to appreciate the extent to which a hospitalization for a serious illness affects children long after their discharge from the hospital, and that surviving the acute illness and returning home is not the end of the story,” study researcher Elizabeth Killien, MD, pediatric critical care medicine fellow at the University of Washington School of Medicine, told Infectious Disease News. “This research demonstrates that many children continue to struggle with attention span, walking or running, sleep, memory, or finishing school assignments for months after they leave the hospital following a serious infection.”
To evaluate the frequency and risk of deterioration in those with pediatric community-acquired sepsis, the researchers conducted a retrospective cohort study of children (n = 778) admitted to Seattle Children’s Hospital between 2012 and 2015 whose symptoms met the 2005 consensus sepsis criteria within 4 hours of presentation.
Killien and colleagues measured the children’s health-related quality of life (HRQL) before admission and after discharge using the Pediatric Quality of Life Inventory measurement model, and they identified patients who failed to recover within 4.5 quality of life points of their baseline. The researchers conducted additional analyses to determine associations between patient and illness characteristics and recovery failures.
Among children included in the analysis, 23.4% failed to recover, which persisted up to 140 days after discharge. Factors associated with failed recovery included sepsis category (50% with septic shock, 30.3% with severe sepsis and 21.9% with sepsis). Additional risk factors included ICU admission (36.7%), site of infection (blood, 55.6%; central nervous system [CNS], 52.9%), immune compromise (39.6%), Pediatric Medical Complexity Algorithm category (complex chronic, 30.3%), longer length of stay and shorter time to follow-up.
In a multivariable regression model, failure to recover was associated with septic shock (RR = 1.64; 95% CI,1.04-2.58), CNS infection (RR = 1.92; 95% CI, 1.13-3.24) and immune compromise (RR = 1.80; 95% CI, 1.35-2.41). Longer lengths of hospital stay were associated with failure to recover only among patients who were not admitted to an ICU (RR = 1.04 per day; 95% CI, 1.01-1.07).
“This research demonstrated that children with underlying chronic health problems, immune suppression, infections in their blood or brain, and those with the most severe illnesses and longest hospitalizations were most at risk for health-related quality of life declines,” Killien said in an interview. “Identifying that this is a common problem, and knowing which children are most at risk, will allow us to better support children and families after they leave the hospital to help them recover to their previous quality of life.” – by Katherine Bortz
- Reference:
- Killien E, et al. Abstract 3535. Presented at: Pediatric Academic Societies Meeting; May 6-9, 2017; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.