Improvement in Health-Related Quality of Life After Community Acquired Pediatric Septic Shock

Area of Science:

• Pediatric critical care medicine
• Quality of life research
• Pediatric critical illness outcomes

Background:

• Pediatric sepsis survivors' health-related quality of life (HRQL) outcomes vary, with some experiencing decline and others returning to baseline.
• It remains unknown if pediatric sepsis survivors can achieve HRQL improvements exceeding their pre-illness levels.
• This study investigated the potential for HRQL improvement in pediatric sepsis survivors with below-average baseline scores.

Purpose of the Study:

• To determine if pediatric sepsis survivors with baseline HRQL scores below the population mean could achieve a 10% or greater improvement.
• To identify factors associated with HRQL improvement in this cohort.
• To evaluate the sustainability of HRQL improvements at 12-month follow-up.

Main Methods:

• Secondary analysis of the prospective Life After Pediatric Sepsis Evaluation study.
• Included children aged 1 month to 18 years with community-acquired septic shock admitted to US academic PICUs.
• Excluded patients with good baseline HRQL (scores > 80) to focus on potential improvers; HRQL measured by PedsQL or Stein-Jessop.

Main Results:

• Of 117 eligible children, 61 (52%) demonstrated ≥10% HRQL improvement by 3 months.
• Lower pre-sepsis HRQL was significantly associated with increased odds of improvement at 3 months (aOR=1.08) and 12 months (OR=1.05).
• HRQL improvement was most prevalent at 3 months; improvement was less sustained at 12 months for children with severe developmental delay compared to those without.

Conclusions:

• Over half of pediatric septic shock survivors with suboptimal baseline HRQL experienced significant improvement within 3 months.
• Lower baseline HRQL predicts a greater likelihood of improvement post-sepsis.
• Severe developmental delay may hinder the long-term sustainability of HRQL gains following pediatric sepsis.