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Published on: August 25, 2014
Trajectory and Risk Factors of Persistent Decline in Health-Related Quality of Life after Septic Shock in Children
Andrew Prout1, Russell K Banks2, Ron W Reeder2
1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan, and Central Michigan University College of Medicine, Mt. Pleasant, Michigan, United States.
Insights
Children with preexisting neurologic disability recover health-related quality of life (HRQL) faster after septic shock than those without. Higher baseline HRQL and acute kidney injury are risk factors for reduced HRQL in survivors.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Public health
Background:
- Preexisting neurologic disability is a significant factor in pediatric septic shock outcomes.
- Assessing health-related quality of life (HRQL) is crucial for understanding long-term recovery in these children.
Purpose of the Study:
- To analyze the burden, trajectory, and risk factors for reduced HRQL in children with preexisting neurologic disability following community-acquired septic shock.
- To compare HRQL recovery between children with and without preexisting neurologic disability.
Main Methods:
- Secondary analysis of the multicenter Life After Pediatric Sepsis Evaluation (LAPSE) cohort study.
- Evaluation of HRQL using the Pediatric Quality of Life Inventory and Stein-Jessop Functional Status Scale at multiple time points.
- Multivariable modeling to identify risk factors for reduced HRQL at 3 months post-sepsis.
Main Results:
- Children with preexisting neurologic disability showed less initial HRQL decline at days 7 and 28 compared to those without.
- No significant difference in HRQL decline was observed at 3 months.
- Higher baseline HRQL and acute renal dysfunction were associated with reduced HRQL (<90% of baseline) at 3 months in neurologically disabled survivors.
Conclusions:
- Children with preexisting neurologic disability tend to recover their HRQL to baseline levels sooner after septic shock.
- Identifying risk factors like baseline HRQL and acute kidney injury is vital for targeted interventions in neurologically disabled pediatric sepsis survivors.
Abstract:
Preexisting neurologic disability is common among children with septic shock. Life After Pediatric Sepsis Evaluation (LAPSE) was a multicenter cohort study that evaluated health-related quality of life (HRQL) in children with community-acquired septic shock. In this secondary analysis of LAPSE, we described the burden, trajectory, and risk factors for reduced HRQL in children with preexisting neurologic disability. Children (1 month-18 years) with community-acquired septic shock were evaluated for HRQL at baseline (reflecting prehospitalization status), day 7 and 28, and month 3, 6, and 12 following admission using the Pediatric Quality of Life Inventory or the Stein-Jessop Functional Status Scale. HRQL was expressed as a percentage of baseline scores. Of 365 evaluable children, 133 (36%) had preexisting neurologic disability. Neurologically disabled children had less decline in HRQL at day 7 (median -15% [interquartile range IQR: -38, 8] vs. -22% [-51, -3], p = 0.005) and day 28 (4% [-16, 22] vs. -11% [-37, 7], p < 0.001) than those without neurologic disability, and there was no difference in the extent of decline at month 3 ( p = 0.241). Using multivariable modeling, higher baseline HRQL (odds ratio [OR] = 1.04 [95% confidence interval [CI]: 1.00, 1.08], p = 0.027) and acute renal dysfunction (OR = 1.08 [1.02, 1.16], p = 0.007) were associated with HRQL less than 90% of baseline at month 3 in neurologically disabled children who survived. Children with preexisting neurologic disability recover to baseline HRQL after septic shock sooner than those without neurologic disability. Higher baseline HRQL and acute renal dysfunction are risk factors for reduced HRQL in neurologically disabled children who survive sepsis.
