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

• Published in: Annals of intensive care Vol. 11; no. 1; p. 102
• Main Authors: Urbina, Tomas, Canoui-Poitrine, Florence, Hua, Camille, Layese, Richard, Alves, Aline, Ouedraogo, Rachida, Bosc, Romain, Sbidian, Emilie, Chosidow, Olivier, Dessap, Armand Mekontso, de Prost, Nicolas
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 02-07-2021; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Cohort analysis; Critical care; Critical Care Medicine; Emergency Medicine; Gangrene; Infections; Intensive; Intensive care; Life Sciences; Medicine; Medicine & Public Health; Mental depression; Necrotizing fasciitis; Necrotizing soft-tissue infection; Post traumatic stress disorder; Quality of life; Sepsis; Septic shock; SF-36; Survivor; Necrotizing fasciitis; Outcome; Critical care; Septic shock; Necrotizing soft-tissue infection; Intensive care unit; Quality of life; SF-36
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-021-00891-9

Background
Compared 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.
Results
Forty-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].
Conclusions
Long-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.