Naomi E Hammond1,2, Simon R Finfer3,4, Qiang Li3, Colman Taylor3, Jeremy Cohen5, Yaseen Arabi6, Rinaldo Bellomo7, Laurent Billot3, Meg Harward3,8, Christopher Joyce8,9, Colin McArthur10, John Myburgh3,11, Anders Perner12, Dorrilyn Rajbhandari3, Andrew Rhodes13, Kelly Thompson3, Steve Webb14,15, Balasubramanian Venkatesh3,8,16,9. 1. Statistics Division, The George Institute for Global Health, UNSW Sydney, Newtown, Australia. nhammond@georgeinstitute.org.au. 2. Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia. nhammond@georgeinstitute.org.au. 3. Statistics Division, The George Institute for Global Health, UNSW Sydney, Newtown, Australia. 4. Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia. 5. Royal Brisbane and Women's Hospital, Brisbane, Australia. 6. King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. 7. Austin and Repatriation Medical Center, Melbourne, Australia. 8. Princess Alexandra Hospital, Brisbane, Australia. 9. The Wesley Hospital, Brisbane, Australia. 10. Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand. 11. St. George Hospital, Sydney, Australia. 12. Rigshospitalet, Copenhagen, Denmark. 13. St. George's Healthcare NHS Trust, London, UK. 14. Royal Perth Hospital, Perth, Australia. 15. School of Medicine and Pharmacology, University of Western Australia, Perth, Australia. 16. The University of Queensland, Brisbane, Australia.
Abstract
PURPOSE: To investigate the impact of hydrocortisone treatment and illness severity on health-related quality of life (HRQoL) at 6 months in septic shock survivors from the ADRENAL trial. METHODS: Using the EuroQol questionnaire (EQ-5D-5L) at 6 months after randomization we assessed HRQoL in patient subgroups defined by hydrocortisone or placebo treatment, gender, illness severity (APACHE II < or ≥ 25), and severity of shock (baseline peak catecholamine doses < or ≥ 15 mcg/min). Additionally, in subgroups defined by post-randomisation variables; time to shock reversal (days), treatment with renal replacement therapy (RRT), and presence of bacteremia. RESULTS: At 6 months, there were 2521 survivors. Of these 2151 patients (85.3%-1080hydrocortisone and 1071 placebo) completed 6-month follow-up. Overall, at 6 months the mean EQ-5D-5L visual analogue scale (VAS) was 70.8, mean utility score 59.4. Between 15% and 30% of patients reported moderate to severe problems in any given HRQoL domain. There were no differences in any EQ-5D-5L domain in patients who received hydrocortisone vs. placebo, nor in the mean VAS (p = 0.6161), or mean utility score (p = 0.7611). In all patients combined, males experienced lower pain levels compared to females [p = 0.0002). Neither higher severity of illness or shock impacted reported HRQoL. In post-randomisation subgroups, longer time to shock reversal was associated with increased problems with mobility (p = < 0.0001]; self-care (p = 0.0.0142), usual activities (p = <0.0001] and pain (p = 0.0384). Amongst those treated with RRT, more patients reported increased problems with mobility (p = 0.0307) and usual activities (p = 0.0048) compared to those not treated. Bacteraemia was not associated with worse HRQoL in any domains of the EQ-5D-5L. CONCLUSIONS: Approximately one fifth of septic shock survivors report moderate to extreme problems in HRQoL domains at 6 months. Hydrocortisone treatment for septic shock was not associated with improved HRQoL at 6 months. Female gender was associated with worse pain at 6 months.
RCT Entities:
PURPOSE: To investigate the impact of hydrocortisone treatment and illness severity on health-related quality of life (HRQoL) at 6 months in septic shock survivors from the ADRENAL trial. METHODS: Using the EuroQol questionnaire (EQ-5D-5L) at 6 months after randomization we assessed HRQoL in patient subgroups defined by hydrocortisone or placebo treatment, gender, illness severity (APACHE II < or ≥ 25), and severity of shock (baseline peak catecholamine doses < or ≥ 15 mcg/min). Additionally, in subgroups defined by post-randomisation variables; time to shock reversal (days), treatment with renal replacement therapy (RRT), and presence of bacteremia. RESULTS: At 6 months, there were 2521 survivors. Of these 2151 patients (85.3%-1080 hydrocortisone and 1071 placebo) completed 6-month follow-up. Overall, at 6 months the mean EQ-5D-5L visual analogue scale (VAS) was 70.8, mean utility score 59.4. Between 15% and 30% of patients reported moderate to severe problems in any given HRQoL domain. There were no differences in any EQ-5D-5L domain in patients who received hydrocortisone vs. placebo, nor in the mean VAS (p = 0.6161), or mean utility score (p = 0.7611). In all patients combined, males experienced lower pain levels compared to females [p = 0.0002). Neither higher severity of illness or shock impacted reported HRQoL. In post-randomisation subgroups, longer time to shock reversal was associated with increased problems with mobility (p = < 0.0001]; self-care (p = 0.0.0142), usual activities (p = <0.0001] and pain (p = 0.0384). Amongst those treated with RRT, more patients reported increased problems with mobility (p = 0.0307) and usual activities (p = 0.0048) compared to those not treated. Bacteraemia was not associated with worse HRQoL in any domains of the EQ-5D-5L. CONCLUSIONS: Approximately one fifth of septic shock survivors report moderate to extreme problems in HRQoL domains at 6 months. Hydrocortisone treatment for septic shock was not associated with improved HRQoL at 6 months. Female gender was associated with worse pain at 6 months.
Authors: Elena Crescioli; Thomas Lass Klitgaard; Lone Musaeus Poulsen; Bjørn Anders Brand; Martin Siegemund; Thorbjørn Grøfte; Frederik Keus; Ulf Gøttrup Pedersen; Minna Bäcklund; Johanna Karttunen; Matthew Morgan; Andrei Ciubotariu; Anne-Marie Gellert Bunzel; Stine Rom Vestergaard; Nicolaj Munch Jensen; Thomas Steen Jensen; Maj-Brit Nørregaard Kjær; Aksel Karl Georg Jensen; Theis Lange; Jørn Wetterslev; Anders Perner; Olav Lilleholt Schjørring; Bodil Steen Rasmussen Journal: Intensive Care Med Date: 2022-04-20 Impact factor: 41.787
Authors: Anne V Grossestreuer; Ari Moskowitz; Lars W Andersen; Mathias J Holmberg; Varun Konacki; Katherine M Berg; Maureen Chase; Michael N Cocchi; Michael W Donnino Journal: Crit Care Explor Date: 2020-11-23