Research & Innovation
Publications
Phenotypes of Functional Decline or Recovery in Sepsis ICU Survivors
PMU Author
Peter Nydahl
All Authors
Keibun Liu, Takaya Nakashima, Tadahiro Goto, Kensuke Nakamura, Hidehiko Nakano, Maiko Motoki, Hiroshi Kamijo, Matsuoka Ayaka, Kenzo Ishii, Yasunari Morita, Takashi Hongo, Nobutake Shimojo, Yukiko Tanaka, Manabu Hanazawa, Tomohiro Hamagami, Kenji Oike, Daisuke Kasugai, Yutaka Sakuda, Yuhei Irie, Masakazu Nitta, Kazuki Akieda, Daigo Shimakura, Hajime Katsukawa, Toru Kotani, Peter Nydahl, Stefan J. Schaller, Takayuki Ogura,
Journal association
CRITICAL CARE MEDICINE
Abstract
OBJECTIVE:Sepsis often leads to heterogeneous symptoms of post-intensive care syndrome (PICS) composing physical, cognitive, and psychiatric disabilities, resulting in deteriorated quality of life (QoL), with limited interventions. This study aimed to identify phenotypes of sepsis-associated PICS by physical, cognitive, and psychiatric function and QoL at hospital discharge. DESIGN:A prospective observational study. SETTING:Twenty-one mixed ICUs. PATIENTS:All consecutive adult patients between November 2020 and April 2022, diagnosed with sepsis at ICU admissions and survived discharge, were enrolled. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Phenotyping with clusters determined by three approaches was performed with following variables at hospital discharge: Barthel Index (<= 90 defined physical PICS), Short Memory Questionnaire (< 40 defined cognitive PICS), Hospital Anxiety and Depression Scale (>= 8 defined psychiatric PICS), Impact of Event Scale-Revised (>= 25 defined psychiatric PICS), EuroQoL 5-dimension 5-level, Clinical Frailty Scale hand-grip strength, and Medical Research Council. Each disability, employment, destination, and survival, were followed over the first year of hospital discharge. In total, 220 ICU patients were included (median age: 72.5 yr, 129 males (59%), 166 septic shocks (75%), and median Sequential Organ Failure Assessment Score: 8). Four phenotypes were identified: group 1 (n = 62) with no PICS, group 2 (n = 55) with mild PICS (physical and cognitive), group 3 (n = 53) with moderate PICS (all domains), and group 4 (n = 50) with severe PICS (all domains). Functional decline and recovery significantly varied among the phenotypes. Physical and cognitive PICS in group 2 improved by the 3-month follow-up, whereas the disabilities in groups 3 and 4 remained over the year. Psychiatric PICS in groups 3 and 4 ameliorated, whereas depression symptoms in group 4 were still evident at the 12-month follow-up. All groups showed persistent moderate to severe reduced QoL and low employment (0-50%). The survival in group 4 continuously decreased. CONCLUSIONS:Four clinical phenotypes of ICU sepsis survivors might contribute to a deeper understanding of post-sepsis trajectories and an individualized treatment approach.
Keywords
SEPSIS, PHENOTYPE, Follow-Up Studies, Intensive Care Units, Post-intensive care syndrome