Trajectories of depression in sepsis survivors: an observational cohort study

Critical Care

Thomas Lehmann¹  James C. Jackson²  Sven Schulz³  Florian P. Wolf³  Monique Boede³  Konrad F. R. Schmidt⁴  Jochen S. Gensichen⁵  Fiene Eißler⁶  Tobias Dreischulte⁷  Juliana J. Petersen⁸ 

[1] Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747, Jena, Germany;Department of Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University, Suite 450, 4th Floor 2525 West End Avenue, 37203, Nashville, TN, USA;Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany;Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany;Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany;Institute of General Practice, Charité University Medicine, Charitéplatz 1, 10117, Berlin, Germany;Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany;Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstr. 10, 80336, Munich, Germany;Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany;Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany;Paediatrics and Adolescent Medicine, Sanaklinikum Lichtenberg, Fanningerstraße 32, 10365, Berlin, Germany;Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstr. 10, 80336, Munich, Germany;Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt a. Main, Germany;

关键词: Sepsis;    Post-intensive care syndrome (PICS);    Depression;    Health-related quality of life (HRQOL);    Chronic pain;    Posttraumatic stress disorder (PTSD);    Comorbidity;    Rehabilitation;   

DOI  :  10.1186/s13054-021-03577-7

来源: Springer

【 摘 要 】

BackgroundAdvances in critical care medicine have led to a growing number of critical illness survivors. A considerable part of them suffers from long-term sequelae, also known as post-intensive care syndrome. Among these, depressive symptoms are frequently observed. Depressive symptom trajectories and associated factors of critical illness survivors have rarely been investigated. Study objective was to explore and compare different trajectories of depressive symptoms in sepsis survivors over 1 year after discharge from ICU.MethodsData of a randomized controlled trial on long-term post-sepsis care were analyzed post hoc. Depressive symptoms were collected at 1, 6 and 12 months post-ICU discharge using the Major Depression Inventory (MDI), among others. Statistical analyses comprised descriptive analysis, univariate and multivariate, linear and logistic regression models and Growth Mixture Modeling.ResultsA total of 224 patients were included into this analysis. We identified three latent classes of depressive symptom trajectories: Over the course of 1 year, 152 patients recovered from mild symptoms, 27 patients showed severe persistent symptoms, and 45 patients recovered from severe symptoms. MDI sum scores significantly differed between the three classes of depressive symptom trajectories at 1 and 6 months after ICU discharge (p < 0.024 and p < 0.001, respectively). Compared with other classes, patients with the mild recovered trajectory showed lower levels of chronic pain (median sum score of 43.3 vs. 60.0/53.3 on the Graded Chronic Pain Scale, p < 0.010) and posttraumatic stress (4.6% with a sum score of ≥ 35 on the Posttraumatic Stress Scale 10 vs. 48.1%/33.3%, p < 0.003); and higher levels of health-related quality of life (HRQOL) using the Short Form-36 scale within 1 month after ICU discharge (p < 0.035).ConclusionsIn the first year after discharge from ICU, sepsis survivors showed three different trajectories of depressive symptoms. Course and severity of depressive symptoms were associated with chronic pain, posttraumatic stress and reduced HRQOL at discharge from ICU. Regular screening of sepsis survivors on symptoms of depression, chronic pain and posttraumatic stress within 1 year after ICU may be considered.Trial registration ISRCTN, ISRCTN 61744782. Registered April 19, 2011—Retrospectively registered, http://www.isrctn.com/ISRCTN61744782.

【 授权许可】

CC BY