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

Background: Although some pediatric sepsis survivors experience worsening health-related quality of life (HRQL), many return to their pre-illness HRQL. Whether children can improve beyond baseline is not known. We examined a cohort of pediatric sepsis survivors to determine if those with baseline HRQL scores below the population mean could exhibit ≥10% improvement and evaluated factors associated with improvement. Methods: In this secondary analysis of the Life After Pediatric Sepsis Evaluation prospective study, children aged 1 month to 18 years admitted to 12 academic PICUs in the United States with community-acquired septic shock who survived to 3 months and had baseline HRQL scores ≤ 80 (i.e., excluding those with good baseline HRQL to allow for potential improvement) were included. HRQL was measured using the Pediatric Quality of Life Inventory or Stein-Jessop Functional Status Scale. Findings: One hundred and seventeen children were eligible. Sixty-one (52%) had ≥ 10% improvement in HRQL by 3 months. Lower pre-sepsis HRQL was associated with increased odds of improvement at 3 months [aOR = 1.08, 95% CI (1.04-1.11), p < 0.001] and 12 months [OR = 1.05, 95% CI (1.02-1.11), p = 0.005]. Improvement in HRQL was most prevalent at 3 month follow-up; at 12 month follow-up, improvement was more sustained among children without severe developmental delay compared to children with severe developmental delay. Interpretation: More than half of these children with community acquired septic shock experienced at least a 10% improvement in HRQL from baseline to 3 months. Children with severe developmental delay did not sustain this improvement at 12 month follow-up.
Competing Interests: JC was funded by the NICHD and NIGMS. MH serves as a paid consultant to LaJolla Pharmaceuticals, and he receives licensing income from Kiadis. Both relationships are unrelated to the content of the current manuscript. RH serves on Data Safety Monitoring Boards for Pfizer, Inc. CN has had financial relationships with Philips Research North America, Hamilton Medical AG, and Nihon Kohden America. JZ has received compensation for the following activities: salary distribution from the University of Washington Medical Group and the Society of Critical Care Medicine (2018–2019 only); royalty payments from Elsevier Publishing for serving as Co-Editor for Pediatric Critical Care; research funding from the National Institutes of Health, Patient-Centered Outcomes Research Institute, Biomedical Advanced Research and Development Authority, and Immunexpress, Seattle; and travel reimbursement to attend board meetings from the Society of Critical Care Medicine. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2021 Pinto, Berg, Zuppa, Newth, Pollack, Meert, Hall, Quasney, Sapru, Carcillo, McQuillen, Mourani, Chima, Holubkov, Nadkarni, Reeder, Zimmerman and the Life After Pediatric Sepsis Evaluation (LAPSE) Investigators.)