Health-related quality of life and functional recovery after intensive care for sepsis in a national cohort.

INTRODUCTION

Functional recovery after intensive care is an important patient-centered outcome. In this study, we investigated risk factors for poor outcome after intensive care for sepsis using serial health-related quality of life (HRQoL) assessments and the burden of work incapacity as an objective proxy for functional recovery.

METHODS

We acquired data on all adult intensive care unit (ICU) patients with sepsis in Sweden between 2008 and 2020. Primary outcome was HRQoL assessed with RAND-36 at follow-up after ICU discharge. Sick-leave information was acquired on the working-age subpopulation to assess the burden of work incapacity.

RESULTS

RAND-36 data were available for 14,006 individuals and was lower than Swedish population reference levels. Males had higher RAND-36. Age had varying associations. Pre-ICU comorbidities were associated with lower RAND-36, whereas severity of illness was associated with lower general health. Invasive ventilation was associated with higher RAND-36, while continuous renal replacement therapy and length of stay (LoS) were associated with lower RAND-36. RAND-36 increased with time after ICU. Sick-leave length was associated with lower RAND-36. High levels of sick leave were seen in patients before intensive care for sepsis, suggesting pre-existing vulnerability. Sick leave increased further after sepsis and did not return to baseline, suggesting incomplete functional recovery, with lower education, female sex, and comorbidities as risk factors.

CONCLUSIONS

In conclusion, in a Swedish national cohort of ICU patients surviving sepsis, HRQoL was low but improved over time. Severity of illness had minimal impact on HRQoL, while LoS and comorbidities were negative factors. Functional recovery in the form of days on sick leave showed a similar pattern.

STUDY REGISTRATION: The study was registered with clinicaltrials.gov: NCT06368336, on the 15th of April 2024.