Quality of life in ICU survivors with severe sepsis who received activated protein C

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Abstract

Appropriate treatment of severe sepsis with activated protein C (rhAPC) has been associated with an absolute reduction in mortality of 6.1% [1]. The aim of this study was to followup patients who received rhAPC and to evaluate their quality of life postdischarge from the intensive care unit (ICU). Method Twenty-three patients in our unit were recruited into the ENHANCE study and received rhAPC. The 28 and 90 day mortality was calculated and quality of life was assessed at 90 days using the Short Form-36 (SF-36) [2]. Psychological distress and depression was measured at the same time using the Hospital Anxiety and Depression score (HAD) [3]. Results Twenty-three subjects had at least three or more acute organ dysfunction associated with severe sepsis, with a range of APACHE II scores of 8–33. The median length of stay in ICU for survivors was 16.4 days, and hospital stay post-ICU was 19.5 days. The 28 and 90 day all-cause mortality was 21.7% (five patients) and 26.1% (six patients), respectively. Eight of the 17 survivors completed the SF-36 (Table 1) and HAD forms. HAD scores indicated heightened anxiety in two patients and none were clinically depressed. Table 1 SF-36 scores for patients who received rhAPC, published figures for a general ICU population [4] and those of the UK population [2] Physical function Role Lim physical Role Lim emotion Social function Mental health Energy vitality Pain Health perception rhAPC 69.4 46.9 54.3 91.8 76.0 61.9 84.9 72.3 General ICU [4] 58.9 46.1 56.4 70.9 68.9 44.2 77.6 57.6 UK population [2] 92.5 91.4 85.6 91.3 75.4 64 86.3 78.8 Conclusion Mortality is similar to that already published [1]. Encouraging, the quality of life for these patients is comparable at 90 days with a general ICU population. A limitation is the number of patients. Correction (12 March 2003) The original published version of the abstract (as shown above) included incorrect data in the first sentence of the Results section, the sentence should have read as follows: Results Twenty-three patients had at least one or more acute organ dysfunction associated with severe sepsis, with a range of APACHE II scores of 8-33.

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Short form 36 (SF36) health survey questionnaire: normative data for adults of working age.

C Jenkinson, A. Coulter, L. Wright (1993)

To gain population norms for the short form 36 health survey questionnaire (SF36) in a large community sample and to explore the questionnaire's internal consistency and validity. Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness. The sample was drawn from computerised registers of the family health services authorities for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire. 13,042 randomly selected subjects aged 18-64 years. Scores for the eight health dimensions of the SF36. The survey achieved a response rate of 72% (n = 9332). Internal consistency of the different dimensions of the questionnaire was high. Normative data broken down by age, sex, and social class were consistent with those from previous studies. The SF36 is a potentially valuable tool in medical research. The normative data provided here may further facilitate its validation and use.

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Survival, morbidity, and quality of life after discharge from intensive care.

Jane Eddleston, E Guthrie, Aaron P White (2000)

To assess survival, morbidity (physical and psychological), quality of life (QOL), and employment status of intensive care survivors up to 12 months after discharge from the intensive care unit (ICU). Prospective study. University hospital adult ICU. Between August 1, 1995, and July 31, 1996, 370 patients were admitted. Of these patients, 29% died in the ICU. Three months after discharge from the ICU, 227 patients were alive, and 143 agreed to participate. Cumulative mortality was calculated using the original complete cohort. Demographic data, severity of acute illness (Acute Physiology and Chronic Health Evaluation [APACHE] II), admitting specialty, primary diagnosis, and length of stay were recorded. Physical and ICU-related psychological morbidity (Hospital Anxiety and Depression scale score) were recorded. Health-related QOL was assessed using the Short-Form 36. All the questionnaires were completed in the clinic at 3 months. Assessment of physical morbidity and employment status at 6 and 12 months were conducted by telephone. The cumulative mortality was 39% at 3 months, 41% at 6 months, and 43% at 12 months. Deaths after 3 months occurred in the group who refused follow-up. The median age for the follow-up group was 51 yrs; the gender split was 68 women and 75 men; the mean admission APACHE II score was 18.79 (SD 6.15); and the median length of ICU stay was 3.8 days. At 3 months, approximately 80% of all patients interviewed were satisfied with their QOL. Older men (>65 yrs) and younger women ( or =8) was low: 11.9% had heightened anxiety, and 9.8% were depressed. There were high levels of fatigue, poor concentration, and sleep disturbance; the latter was more marked in women (p = .022). Improvement in all three symptoms occurred during the next 9 months. Significantly more women reported loss of hair (p < .0001). Men were slower to return to employment; 75% of women had returned by 6 months compared with only 65% of men at 1 yr. Assessment of outcome after ICU stay must include QOL measurements. Three months after discharge, there is a low incidence of ICU-related psychological or psychiatric illness and the majority of patients are satisfied. Differences in the incidence and nature of morbidity exist between the genders.