Trajectory and Risk Factors of Persistent Decline in Health-Related Quality of Life after Septic Shock in Children with Preexisting Neurologic Disability

Andrew Prout; Russell K. Banks; Ron W. Reeder; Jerry J. Zimmerman; Kathleen L. Meert

doi:10.1055/s-0041-1741402

Journal of Pediatric Intensive Care, Table of Contents

J Pediatr Intensive Care 2024; 13(03): 242-252
DOI: 10.1055/s-0041-1741402

Original Article

Trajectory and Risk Factors of Persistent Decline in Health-Related Quality of Life after Septic Shock in Children with Preexisting Neurologic Disability

Andrew Prout

¹Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan, and Central Michigan University College of Medicine, Mt. Pleasant, Michigan, United States

,

Russell K. Banks

²Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States

,

Ron W. Reeder

²Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States

,

Jerry J. Zimmerman

³Department of Pediatrics, Seattle Children's Hospital, Seattle Research Institute, University of Washington School of Medicine, Seattle, Washington, United States

,

Kathleen L. Meert

¹Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan, and Central Michigan University College of Medicine, Mt. Pleasant, Michigan, United States

› Author Affiliations

Abstract

Preexisting neurologic disability is common among children with septic shock. Life After Pediatric Sepsis Evaluation (LAPSE) was a multicenter cohort study that evaluated health-related quality of life (HRQL) in children with community-acquired septic shock. In this secondary analysis of LAPSE, we described the burden, trajectory, and risk factors for reduced HRQL in children with preexisting neurologic disability. Children (1 month–18 years) with community-acquired septic shock were evaluated for HRQL at baseline (reflecting prehospitalization status), day 7 and 28, and month 3, 6, and 12 following admission using the Pediatric Quality of Life Inventory or the Stein–Jessop Functional Status Scale. HRQL was expressed as a percentage of baseline scores. Of 365 evaluable children, 133 (36%) had preexisting neurologic disability. Neurologically disabled children had less decline in HRQL at day 7 (median −15% [interquartile range IQR: −38, 8] vs. −22% [−51, −3], p = 0.005) and day 28 (4% [−16, 22] vs. −11% [−37, 7], p < 0.001) than those without neurologic disability, and there was no difference in the extent of decline at month 3 (p = 0.241). Using multivariable modeling, higher baseline HRQL (odds ratio [OR] = 1.04 [95% confidence interval [CI]: 1.00, 1.08], p = 0.027) and acute renal dysfunction (OR = 1.08 [1.02, 1.16], p = 0.007) were associated with HRQL less than 90% of baseline at month 3 in neurologically disabled children who survived. Children with preexisting neurologic disability recover to baseline HRQL after septic shock sooner than those without neurologic disability. Higher baseline HRQL and acute renal dysfunction are risk factors for reduced HRQL in neurologically disabled children who survive sepsis.

Keywords

health-related quality of life - neurologic disability - sepsis - infant - child

Full Text

References

References
1 Tan B, Wong JJM, Sultana R. et al. Global case-fatality rates in pediatric severe sepsis and septic shock: a systematic review and meta-analysis. JAMA Pediatr 2019; 173 (04) 352-362
2 Zimmerman JJ, Banks R, Berg RA. et al; Life After Pediatric Sepsis Evaluation (LAPSE) Investigators. Trajectory of mortality and health-related quality of life morbidity following community-acquired pediatric septic shock. Crit Care Med 2020; 48 (03) 329-337
3 Weiss SL, Fitzgerald JC, Pappachan J. et al; Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med 2015; 191 (10) 1147-1157
4 Zimmerman JJ, Banks R, Berg RA. et al; Life After Pediatric Sepsis Evaluation (LAPSE) Investigators. Critical illness factors associated with long-term mortality and health-related quality of life morbidity following community-acquired pediatric septic shock. Crit Care Med 2020; 48 (03) 319-328
5 Prout AJ, Talisa VB, Carcillo JA. et al. Children with chronic disease bear the highest burden of pediatric sepsis. J Pediatr 2018; 199: 194-199.e1
6 Carlton EF, Kohne JG, Shankar-Hari M, Prescott HC. Readmission diagnoses after pediatric severe sepsis hospitalization. Crit Care Med 2019; 47 (04) 583-590
7 Prout AJ, Talisa VB, Carcillo JA, Angus DC, Chang CH, Yende S. Epidemiology of readmissions after sepsis hospitalization in children. Hosp Pediatr 2019; 9 (04) 249-255
8 Heneghan JA, Reeder RW, Dean JM. et al. Characteristics and outcomes of critical illness in children with feeding and respiratory technology dependence. Pediatr Crit Care Med 2019; 20 (05) 417-425
9 Choong K, Fraser D, Al-Harbi S. et al. Functional recovery in critically ill children, the “WeeCover” multicenter study. Pediatr Crit Care Med 2018; 19 (02) 145-154
10 Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014; 14 (01) 199
11 Edwards JD, Houtrow AJ, Vasilevskis EE. et al. Chronic conditions among children admitted to U.S. pediatric intensive care units: their prevalence and impact on risk for mortality and prolonged length of stay*. Crit Care Med 2012; 40 (07) 2196-2203
12 Fiser DH. Assessing the outcome of pediatric intensive care. J Pediatr 1992; 121 (01) 68-74
13 Simon TD, Cawthon ML, Stanford S. et al; Center of Excellence on Quality of Care Measures for Children with Complex Needs (COE4CCN) Medical Complexity Working Group. Pediatric medical complexity algorithm: a new method to stratify children by medical complexity. Pediatrics 2014; 133 (06) e1647-e1654
14 Pollack MM, Holubkov R, Glass P. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. Functional Status Scale: new pediatric outcome measure. Pediatrics 2009; 124 (01) e18-e28
15 Pollack MM, Holubkov R, Funai T. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network. The Pediatric Risk of Mortality Score: update 2015. Pediatr Crit Care Med 2016; 17 (01) 2-9
16 Leteurtre S, Duhamel A, Salleron J, Grandbastien B, Lacroix J, Leclerc F. ; Groupe Francophone de Réanimation et d'Urgences Pédiatriques (GFRUP). PELOD-2: an update of the PEdiatric logistic organ dysfunction score. Crit Care Med 2013; 41 (07) 1761-1773
17 Leteurtre S, Duhamel A, Deken V, Lacroix J, Leclerc F. Groupe Francophone de Réanimation et Urgences Pédiatriques. Daily estimation of the severity of organ dysfunctions in critically ill children by using the PELOD-2 score. Crit Care 2015; 19 (01) 324
18 Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr 2003; 3 (06) 329-341
19 Varni JW, Limbers CA, Neighbors K. et al. The PedsQL™ Infant Scales: feasibility, internal consistency reliability, and validity in healthy and ill infants. Qual Life Res 2011; 20 (01) 45-55
20 Stein REK, Jessop DJ. Functional status II(R). A measure of child health status. Med Care 1990; 28 (11) 1041-1055
21 Starr MC, Banks R, Reeder RW. et al. Severe acute kidney injury is associated with increased risk of death and new morbidity after pediatric septic shock. Pediatr Crit Care Med 2020; 21 (09) E686-E695
22 Polic B, Mestrovic J, Markic J. et al. Long-term quality of life of patients treated in paediatric intensive care unit. Eur J Pediatr 2013; 172 (01) 85-90
23 Mestrovic J, Kardum G, Sustic A. et al. Neurodevelopmental disabilities and quality of life after intensive care treatment. J Paediatr Child Health 2007; 43 (10) 673-676
24 Lemmon ME, Huffstetler HE, Reeve BB. Measuring health-related quality of life in pediatric neurology. J Child Neurol 2020; 35 (10) 681-689
25 Colville G, Cream P. Post-traumatic growth in parents after a child's admission to intensive care: maybe Nietzsche was right?. Intensive Care Med 2009; 35 (05) 919-923
26 Beighton C, Wills J. How parents describe the positive aspects of parenting their child who has intellectual disabilities: a systematic review and narrative synthesis. J Appl Res Intellect Disabil 2019; 32 (05) 1255-1279
27 Sprangers MAG, Schwartz CE. Integrating response shift into health-related quality of life research: a theoretical model. Soc Sci Med 1999; 48 (11) 1507-1515
28 Sajobi TT, Speechley KN, Liang Z, Goodwin SW, Ferro MA, Wiebe S. Response shift in parents' assessment of health-related quality of life of children with new-onset epilepsy. Epilepsy Behav 2017; 75: 97-101
29 Richardson KL, Watson RS, Hingorani S. Quality of life following hospitalization-associated acute kidney injury in children. J Nephrol 2018; 31 (02) 249-256
30 Fitzgerald JC, Basu RK, Akcan-Arikan A. et al; Sepsis PRevalence, OUtcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Acute kidney injury in pediatric severe sepsis: an independent risk factor for death and new disability. Crit Care Med 2016; 44 (12) 2241-2250
31 Janse AJ, Sinnema G, Uiterwaal CSPM, Kimpen JLL, Gemke RJBJ. Quality of life in chronic illness: children, parents and paediatricians have different, but stable perceptions. Acta Paediatr 2008; 97 (08) 1118-1124

Supplementary Material

Supplementary Material