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

Abstract

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.

Healthcare trajectory of critically ill patients with necrotizing soft tissue infections: a multicenter retrospective cohort study using the clinical data warehouse of Greater Paris University Hospitals

“…After the acute phase, 32.3% of patients required a remote skin graft, after a median time of 28 days (13–39) after the first surgical debridement, with no significant difference within both predefined subgroups. Consistent with previous series [ 8 ], 15.7% of patients underwent amputation.…”

“…Hospital mortality ranges from 9.3 to 29.3%, with disabling sequelae for 30% of survivors [ 1 , 6 , 7 ]. Morbidity among survivors includes potential amputations and profound impact on long-term health-related quality of life [ 3 , 8 , 9 ]. Initial misdiagnosis is frequent [ 10 ], leading to a delayed surgical debridement of infected tissues, one of the main modifiable prognostic factors [ 11 ].…”

Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges

“…In the year following ICU discharge, survivors displayed a severe reduction in force development and endurance contraction [ 8 ], reported by patients as impacting physical performance and health-related QOL [ 9 ]. These consequences persist at 5 years with a persistent limitation in the 6-min walk test [ 10 – 12 ], an impairment in aerobic capacities (decrease in VO2 max) frequently involved in muscle limitations [ 13 ], and still have an impact on physical performance and health-related QOL [ 10 – 12 ]. This has been mainly studied after septic shock [ 9 ] and ARDS [ 10 – 12 ].…”

Impact of severe necrotizing fasciitis on quality of life in the Netherlands

“…Czymek et al research about QoL after Fournier’s gangrene showed similar results as Suijker et al, lowered levels of HRQoL in the physical domains [ 15 ]. Urbina et al found that patients suffering from necrotizing skin and soft-tissue infections (NSTI) had lower levels of HRQoL in multiple subdomains when compared to non-NSTI septic shock patients and when compared to NSTI patients which were not admitted to the ICU during hospitalization [ 16 ]. When compared to the research about burns these research are all much smaller (number of cases range from 10 to 30) and no systematic review has been performed yet.…”