Care pathways of sepsis survivors: sequelae, mortality and use of healthcare services in France, 2015–2018

Abstract

Background Individuals who survive sepsis are at high risk of chronic sequelae, resulting in significant health-economic costs. Several studies have focused on aspects of healthcare pathways of sepsis survivors but comprehensive, longitudinal overview of their pathways of care are scarce. The aim of this retrospective, longitudinal cohort study is to identify sepsis survivor profiles based on their healthcare pathways and describe their healthcare consumption and costs over the 3 years following their index hospitalization. Methods The data were extracted from the French National Hospital Discharge Database. The study population included all patients above 15 years old, with bacterial sepsis, who survived an incident hospitalization in an acute care facility in 2015. To identify survivor profiles, state sequence and clustering analyses were conducted over the year following the index hospitalization. For each profile, patient characteristics and their index hospital stay and sequelae were described, as well as use of care and its associated monetary costs, both pre- and post-sepsis. Results New medical (79.2%), psychological (26.9%) and cognitive (18.5%) impairments were identified post-sepsis, and 65.3% of survivors were rehospitalized in acute care. Cumulative mortality reached 36.6% by 3 years post-sepsis. The total medical cost increased by 856 million € in the year post-sepsis. Five patient clusters were identified: home (65.6% of patients), early death (12.9%), late death (6.8%), short-term rehabilitation (11.3%) and long-term rehabilitation (3.3%). Survivors with early and late death clusters had high rates of cancer and primary bacteremia and experienced more hospital-at-home care post-sepsis. Survivors in short- or long-term rehabilitation clusters were older, with higher percentage of septic shock than those coming back home, and had high rates of multiple site infections and higher rates of new psychological and cognitive impairment. Conclusions Over three years post-sepsis, different profiles of sepsis survivors were identified with different mortality rates, sequels and healthcare services usage and cost. This study confirmed the importance of sepsis burden and suggests that strategies of post-discharge care, in accordance with patient profile, should be further tested in order to reduce sepsis burden.

Screening and Application of DNA Aptamers for Heparin-Binding Protein

“…Sepsis is a systemic inflammatory response syndrome caused by infection, commonly seen in patients with severe trauma or infectious diseases [32]. According to statistical data, sepsis exhibits a high incidence and mortality rate, rendering it the primary cause of fatality among critically ill patients in intensive care units [33,34]. Furthermore, survivors often experience a significant impact on their quality of life, frequently accompanied by neuromuscular weakness, functional decline, depression, anxiety, and post-traumatic stress syndrome [35].…”

Immunotherapy in the context of sepsis-induced immunological dysregulation

“…Furthermore, a recent study estimated the annual direct and indirect economic costs associated with sepsis in the Netherlands to be between 3.8 and 6.5 billion euros ( 4 ). Moreover, survivors of sepsis from different demographics may experience various adverse outcomes, such as long-term neurodevelopmental abnormalities and physical dysfunctions in neonates, as well as cognitive impairments and psychological issues such as depression and anxiety ( 5 – 8 ). These phenomena are not only related to the rapid progression and unpredictable nature of the complex clinical picture but also due to the lack of specific therapeutic measures in current clinical practice.…”