Long-term quality of life in necrotizing soft-tissue infection survivors: a monocentric prospective cohort study

Annals of Intensive Care

Tomas Urbina¹  Romain Bosc²  Aline Alves³  Rachida Ouedraogo³  Nicolas de Prost⁴  Armand Mekontso Dessap⁴  Richard Layese⁵  Camille Hua⁶  Olivier Chosidow⁶  Emilie Sbidian⁷  Florence Canoui-Poitrine⁸ 

[1] Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75571, Paris Cedex 12, France;Sorbonne Université, Université Pierre-Et-Marie Curie, Paris 6, France;Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France;Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France;Henri Mondor Breast Center, Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny, 94000, Créteil, France;Biology of the NeuroMuscular System, INSERM Team U955-E10, Paris East University, 94000, Créteil, France;Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France;Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France;Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France;Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil, France;Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris (AP-HP), Créteil, France;Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France;Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris (AP-HP), Créteil, France;Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France;Service de Dermatologie, Hôpitaux Universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris (AP-HP), Créteil, France;Centre D’Investigation Clinique 1430, Inserm, 94010, Créteil, France;Université Paris-Est Créteil Val de Marne (UPEC), Créteil, France;Service de Santé Publique, Hôpitaux Universitaires Henri Mondor, Assistance Publique – Hôpitaux de Paris (AP-HP), Créteil, France;

关键词: Necrotizing soft-tissue infection;    Necrotizing fasciitis;    Quality of life;    Critical care;    Septic shock;    SF-36;    Intensive care unit;    Outcome;   

DOI  :  10.1186/s13613-021-00891-9

来源: Springer

【 摘 要 】

BackgroundCompared to other life-threatening infection survivors, long-term health-related quality of life (QOL) of patients surviving necrotizing soft-tissue infections (NSTI) and its determinants are little known.In this monocentric prospective cohort including NSTI survivors admitted between 2014 and 2017, QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36), the Hospital Anxiety and Depression (HAD), the activity of daily living (ADL), instrumental ADL (IADL) scales and the Impact of Event Scale-Revised (IES-R). The primary outcome measure was the SF-36 physical component summary (PCS). NSTI patients were compared according to intensive care unit (ICU) admission status. ICU survivors were matched on SAPS II with non-NSTI related septic shock survivors.ResultsForty-nine NSTI survivors were phone-interviewed and included in the study. Median PCS was decreased compared to the reference population [− 0.97 (− 2.27; − 0.08) SD]. Previous cardiac disease was the only variable associated with PCS alteration [multivariate regression coefficient: − 8.86 (− 17.64; − 0.07), p  =  0.048]. Of NSTI survivors, 15.2% had a HAD-D score  ≥  5 and 61.2% an IES-R score  ≥  33. ICU admission was not associated with lower PCS [35.21 (25.49–46.54) versus (vs) 41.82 (24.12–51.01), p  =  0.516], but with higher IES-R score [14 (7.5–34) vs 7 (3–18), p  =  0.035] and a higher proportion of HAD-D score  ≥  5 (28.6 vs 4.0%, p  =  0.036). Compared to non-NSTI septic shock-matched controls, NSTI patients had similar PCS [33.81 (24.58; − 44.39) vs 44.87 (26.71; − 56.01), p  =  0.706] but higher HAD-D [3.5 (1–7) vs 3 (1.5–6), p  =  0.048] and IES-R scores [18 (8–35) vs 8 (3–19), p  =  0.049].ConclusionsLong-term QOL in NSTI survivors is severely impaired, similarly to that of non-NSTI septic shock patients for physical compartments, but with more frequent depressive and/or post-traumatic stress disorders. Only ICU admission and previous cardiac disease were predictive of QOL impairment.

【 授权许可】

CC BY