Health-related quality of life in survivors of septic shock : 6-month follow-up from the ADRENAL trial

Journal article

Hammond, Naomi E., Finfer, Simon R., Li, Qiang, Taylor, Colman, Cohen, Jeremy, Arabi, Yaseen, Bellomo, Rinaldo, Billot, Laurent, Harward, Meg, McArthur, Colin, Myburgh, John, Perner, Anders, Rajbhandari, Dorrilyn, Rhodes, Andrew, Thompson, Kelly, Webb, Steven A. and Venkatesh, Balasubramanian. (2020). Health-related quality of life in survivors of septic shock : 6-month follow-up from the ADRENAL trial. Intensive Care Medicine. 46(9), pp. 1696-1706. https://doi.org/10.1007/s00134-020-06169-1
AuthorsHammond, Naomi E., Finfer, Simon R., Li, Qiang, Taylor, Colman, Cohen, Jeremy, Arabi, Yaseen, Bellomo, Rinaldo, Billot, Laurent, Harward, Meg, McArthur, Colin, Myburgh, John, Perner, Anders, Rajbhandari, Dorrilyn, Rhodes, Andrew, Thompson, Kelly, Webb, Steven A. and Venkatesh, Balasubramanian
Abstract

Purpose: To investigate the impact of hydrocortisone treatment and illness severity on health-related quality of life (HRQoL) at 6 months in septic shock survivors from the ADRENAL trial.

Methods: Using the EuroQol questionnaire (EQ-5D-5L) at 6 months after randomization we assessed HRQoL in patient subgroups defined by hydrocortisone or placebo treatment, gender, illness severity (APACHE II < or ≥ 25), and severity of shock (baseline peak catecholamine doses < or ≥ 15 mcg/min). Additionally, in subgroups defined by post-randomisation variables; time to shock reversal (days), treatment with renal replacement therapy (RRT), and presence of bacteremia.

Results: At 6 months, there were 2521 survivors. Of these 2151 patients (85.3%-1080 hydrocortisone and 1071 placebo) completed 6-month follow-up. Overall, at 6 months the mean EQ-5D-5L visual analogue scale (VAS) was 70.8, mean utility score 59.4. Between 15% and 30% of patients reported moderate to severe problems in any given HRQoL domain. There were no differences in any EQ-5D-5L domain in patients who received hydrocortisone vs. placebo, nor in the mean VAS (p = 0.6161), or mean utility score (p = 0.7611). In all patients combined, males experienced lower pain levels compared to females [p = 0.0002). Neither higher severity of illness or shock impacted reported HRQoL. In post-randomisation subgroups, longer time to shock reversal was associated with increased problems with mobility (p = < 0.0001]; self-care (p = 0.0.0142), usual activities (p = <0.0001] and pain (p = 0.0384). Amongst those treated with RRT, more patients reported increased problems with mobility (p = 0.0307) and usual activities (p = 0.0048) compared to those not treated. Bacteraemia was not associated with worse HRQoL in any domains of the EQ-5D-5L.

Conclusions: Approximately one fifth of septic shock survivors report moderate to extreme problems in HRQoL domains at 6 months. Hydrocortisone treatment for septic shock was not associated with improved HRQoL at 6 months. Female gender was associated with worse pain at 6 months.

KeywordsHealth-related quality of life; Intensive care; Steroids; EQ5D; Sepsis; Septic shock
Year01 Jan 2020
JournalIntensive Care Medicine
Journal citation46 (9), pp. 1696-1706
PublisherSpringer
ISSN0342-4642
Digital Object Identifier (DOI)https://doi.org/10.1007/s00134-020-06169-1
Web address (URL)https://link.springer.com/article/10.1007/s00134-020-06169-1
Open accessPublished as non-open access
Research or scholarlyResearch
Page range1696-1706
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online16 Jul 2020
Publication process dates
Accepted30 Jun 2020
Deposited03 Oct 2024
Additional information

© 2020 Springer-Verlag GmbH Germany, part of Springer Nature

Place of publicationGermany
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