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Long-term mortality and quality of life in sepsis: A systematic review*

Winters, Bradford D. MD, PhD; Eberlein, Michael MD, PhD; Leung, Janice MD; Needham, Dale M. MD, PhD; Pronovost, Peter J. MD, PhD; Sevransky, Jonathan E. MD, MHS

doi: 10.1097/CCM.0b013e3181d8cc1d
Continuing Medical Education Articles

Background: Long-term outcomes from sepsis are poorly understood, and sepsis in patients may have different long-term effects on mortality and quality of life. Long-term outcome studies of other critical illnesses such as acute lung injury have demonstrated incremental health effects that persist after hospital discharge. Whether patients with sepsis have similar long-term mortality and quality-of-life effects is unclear.

Objective: We performed a systematic review of studies reporting long-term mortality and quality-of-life data (>3 months) in patients with sepsis, severe sepsis, and septic shock using defined search criteria.

Design: Systematic review of the literature.

Interventions: None.

Main Results: Patients with sepsis showed ongoing mortality up to 2 yrs and beyond after the standard 28-day inhospital mortality end point. Patients with sepsis also had decrements in quality-of-life measures after hospital discharge. Results were consistent across varying severity of illness and different patient populations in different countries, including large and small studies. In addition, these results were consistent within observational and randomized, controlled trials. Study quality was limited by inadequate control groups and poor adjustment for confounding variables.

Conclusions: Patients with sepsis have ongoing mortality beyond short-term end points, and survivors consistently demonstrate impaired quality of life. The use of 28-day mortality as an end point for clinical studies may lead to inaccurate inferences. Both observational and interventional future studies should include longer-term end points to better-understand the natural history of sepsis and the effect of interventions on patient morbidities.

Assistant Professor (BDW), Departments of Anesthesiology and Critical Care Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Critical Care Fellow (ME, JL), National Institutes of Health, Bethesda, MD; Associate Professor (DMN), Johns Hopkins University, Baltimore, MD; Medical Director (DMN), Critical Care Physical Medicine & Rehabilitation Program, Johns Hopkins University, Baltimore, MD; Professor (PJP), Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Assistant Professor of Medicine (JES), Johns Hopkins University, Baltimore, MD; and Medical Director (JES), Johns Hopkins Bayview Medical Center Medical Intensive Care Unit, Johns Hopkins University, Baltimore, MD.

Drs. Winters and Eberlein contributed equally to this work and share first authorship.

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© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins