Health-related Quality of Life (HRQoL) Among Patients Who Have Survived an Episode of Sepsis in the United States: A Systematic Review

OBJECTIVES: Sepsis is a critical illness that may lead to death or otherwise profoundly affect the physical, cognitive, and psychological well-being of those who survive this illness. We sought to identify and synthesize evidence on the impact of sepsis on HRQoL among sepsis survivors in the US.

METHODS: A systematic literature review was conducted in EMBASE, MEDLINE, and MEDLINE In-Process databases to identify studies on HRQoL in patients who survived an episode of sepsis, published between January 2010–September 2023.

RESULTS: Seven publications were identified that met study inclusion criteria. Of these, 4 reported on multidimensional generic QoL measures (e.g., SF-36, EQ-5D), and functional status (e.g., MDS-ADL, FAQ), and 3 on cognitive status (e.g., MDS-COGS), and mental health (e.g., PTSD-8, PROMIS Depression). Timepoints of assessments varied, from 3 months–10 years post-sepsis episode. One study reported mean SF-36 physical and mental summary scores at 6 months post-sepsis, 37 (SD: 12), and 45 (15), respectively. In a cohort study, patients critically ill post-sepsis reported lower physical and mental SF-36 summary scores after 12 months compared with patients who rapidly recovered. Similarly, patients surviving sepsis-induced respiratory/cardiovascular dysfunction had poor median EQ-5D scores 6 months post-sepsis episode (EQ-5D-3L: 70; EQ-5D-3L utility: 0.68; ED-5D-3L VAS: 67), whereas critically ill sepsis patients, admitted to ICU, had very low EQ-5D-3L utility scores after 6 months compared with those admitted to ICU, but who recovered more rapidly (0.37 vs. 0.66, p<0.0001). Sepsis survivors also reported impaired cognitive function and reduced mental health. In one study, MDS-ADL hierarchical scale assessment indicated dependence/total dependence to perform habitual, universal tasks among patients admitted to skilled nursing facilities post-sepsis (72.5% of patients).

CONCLUSIONS: These findings highlight that patients who survive sepsis may experience profound and often long-term negative impacts for HRQoL, including ability to perform activities of daily living, cognitive abilities, and psychological wellbeing.