Trajectories of depression in sepsis survivors: an observational cohort study

Abstract

Background Advances in critical care medicine have led to a growing number of critical illness survivors. A considerable part of them suffers from long-term sequelae, also known as post-intensive care syndrome. Among these, depressive symptoms are frequently observed. Depressive symptom trajectories and associated factors of critical illness survivors have rarely been investigated. Study objective was to explore and compare different trajectories of depressive symptoms in sepsis survivors over 1 year after discharge from ICU. Methods Data of a randomized controlled trial on long-term post-sepsis care were analyzed post hoc. Depressive symptoms were collected at 1, 6 and 12 months post-ICU discharge using the Major Depression Inventory (MDI), among others. Statistical analyses comprised descriptive analysis, univariate and multivariate, linear and logistic regression models and Growth Mixture Modeling. Results A total of 224 patients were included into this analysis. We identified three latent classes of depressive symptom trajectories: Over the course of 1 year, 152 patients recovered from mild symptoms, 27 patients showed severe persistent symptoms, and 45 patients recovered from severe symptoms. MDI sum scores significantly differed between the three classes of depressive symptom trajectories at 1 and 6 months after ICU discharge (p < 0.024 and p < 0.001, respectively). Compared with other classes, patients with the mild recovered trajectory showed lower levels of chronic pain (median sum score of 43.3 vs. 60.0/53.3 on the Graded Chronic Pain Scale, p < 0.010) and posttraumatic stress (4.6% with a sum score of ≥ 35 on the Posttraumatic Stress Scale 10 vs. 48.1%/33.3%, p < 0.003); and higher levels of health-related quality of life (HRQOL) using the Short Form-36 scale within 1 month after ICU discharge (p < 0.035). Conclusions In the first year after discharge from ICU, sepsis survivors showed three different trajectories of depressive symptoms. Course and severity of depressive symptoms were associated with chronic pain, posttraumatic stress and reduced HRQOL at discharge from ICU. Regular screening of sepsis survivors on symptoms of depression, chronic pain and posttraumatic stress within 1 year after ICU may be considered. Trial registration ISRCTN, ISRCTN 61744782. Registered April 19, 2011—Retrospectively registered, http://www.isrctn.com/ISRCTN61744782.

COVID-19: persistence of symptoms and lung alterations after 3–6 months from hospital discharge

“…Weakness and neuropsychiatric complications, including cognitive impairment, depression, and anxiety have been frequently described in intensive care survivors, and may persist for five or more years [ 21 – 23 ]. It is still debated whether long-time persistence of symptoms in patients hospitalized for COVID-19 is pathogenically similar to that observed in ICU patients admitted for other diseases or is specifically related to SARS-CoV-2 infection.…”

Long-Term Outcome of Severe Metabolic Acidemia in ICU Patients, a BICAR-ICU Trial Post Hoc Analysis

“…We can hypothesize by analogy with studies carried out on sepsis and ARDS that this observation results from the combination of muscle loss, cognitive impairment, and psychologic issues (21, 24–27). In a recent study, Boede et al (28) showed an association between depression symptoms, chronic pain, and posttraumatic stress in the year following ICU discharge in sepsis survivors (29). This could suggest that a long-term reduction of depression symptoms compared with the general population may be linked to a resolution of chronic pain and greater acceptance of disability after several years.…”

Prevalence of sepsis among adults in China: A systematic review and meta-analysis

“…Two reviewers independently extracted data on participant and study characteristics according to the guideline for data extraction for systematic reviews and meta-analysis (26), such as first author, publication years, journal, study setting (hospitalacquired or ICU-acquired), sample size, study period, sepsis type, sepsis diagnostic criteria, mean or median age, patients source, sepsis cases, comorbid conditions, number of deaths, risk factors of mortality, duration of ICU or hospital stay, type of infection, infection site and microorganisms. was then classified based on these scores as low (0-5), moderate (6)(7)(8) or high (8)(9)(10), respectively.…”

“…Sepsis is a major global public health concern characterized by high morbidity, high mortality, and heavy economic burden ( 4 ). Sepsis survivors often have long-term physical ( 5 ), psychological ( 6 ), and cognitive impairments ( 7 ) with significant health care and social implications. Thus, improving the prevention, recognition, and treatment of sepsis was declared as a global health priority by the World Health Organization (WHO) in 2017 ( 8 ).…”