Details

Autor(en) / Beteiligte

• Hammond, Naomi E.
• Finfer, Simon R.
• Li, Qiang
• Taylor, Colman
• Cohen, Jeremy
• Arabi, Yaseen
• Bellomo, Rinaldo
• Billot, Laurent
• Harward, Meg
• Joyce, Christopher
• McArthur, Colin
• Myburgh, John
• Perner, Anders
• Rajbhandari, Dorrilyn
• Rhodes, Andrew
• Thompson, Kelly
• Webb, Steve
• Venkatesh, Balasubramanian

Titel

Health-related quality of life in survivors of septic shock: 6-month follow-up from the ADRENAL trial

Ist Teil von

• Intensive care medicine, 2020-09, Vol.46 (9), p.1696-1706

Ort / Verlag

Berlin/Heidelberg: Springer Berlin Heidelberg

Erscheinungsjahr

2020

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.