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https://hdl.handle.net/2440/129072
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Type: | Journal article |
Title: | Health-related quality of life in survivors of septic shock: 6-month follow-up from the ADRENAL trial |
Author: | Hammond, N.E. Finfer, S.R. Li, Q. Taylor, C. Cohen, J. Arabi, Y. Bellomo, R. Billot, L. Harward, M. Joyce, C. McArthur, C. Myburgh, J. Perner, A. Rajbhandari, D. Rhodes, A. Thompson, K. Webb, S. Venkatesh, B. Cowdrey, K.A. Gilder, E. et al. |
Citation: | Intensive Care Medicine, 2020; 46(9):1696-1706 |
Publisher: | Springer |
Issue Date: | 2020 |
ISSN: | 0342-4642 1432-1238 |
Statement of Responsibility: | Naomi E. Hammond, Simon R. Finfer, Qiang Li, Colman Taylor, Jeremy Cohen, Yaseen Arabi ... et al. |
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. |
Keywords: | Health-related quality of life; intensive care; steroids; EQ5D; sepsis; septic; shock |
Rights: | © 2020 Springer Nature Switzerland AG. Part of Springer Nature. |
DOI: | 10.1007/s00134-020-06169-1 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1004108 http://purl.org/au-research/grants/nhmrc/1124926 |
Published version: | http://dx.doi.org/10.1007/s00134-020-06169-1 |
Appears in Collections: | Aurora harvest 8 Medicine publications |
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