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
1
Department 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
3
Department of Pediatrics, Seattle Children's Hospital, Seattle Research Institute, University of Washington School of Medicine, Seattle, Washington, United States
1
Department 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 AffiliationsFunding K.L.M. was supported by the National Institutes of Health grant UG1HD050096—Collaborative Pediatric Critical Care Research Network. R.R. was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant R03R03HD104001). R.K.B. was supported by National Institute of Child Health and Human Development funds paid to the institution. J.J.Z. was supported by National Institutes of Health/National Institute of Child Health and Human Development—grant funding for the LAPSE investigation, Immunexpress, Seattle, WA—research funding, and also by payment from Elsevier Publishing—royalties for co-editing the textbook, Pediatric Critical Care. He was also supported by the Society of Critical Care Medicine—travel reimbursement to attend board meetings
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
Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany
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