Long-term outcomes after severe shock.
Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Seventy-six patients who were alive 90 days after severe shock (received ≥1 μg/kg per minute of norepinephrine equivalent) were eligible for the study. We measured 3-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. The mean long-term survival was 5.1 years; 82% (62 of 76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of 5 years after hospital admission. The patients' Physical Functioning scores were below U.S. population norms (P < 0.001), whereas mental health scores were similar to population norms. Nineteen percent of the patients had symptoms of depression, 39% had symptoms of anxiety, and 8% had symptoms of posttraumatic stress disorder. Thirty-six percent were disabled, and 17% were working full-time. Early survivors of severe shock had a high 3-year survival rate. Patients' long-term physical and psychological outcomes were similar to those reported for cohorts of less severely ill intensive care unit survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely critically ill patients have similar outcomes to general intensive care unit survivor populations.
*Pulmonary and Critical Care Medicine, Intermountain Medical Center; †Center for Humanizing Critical Care, Intermountain Healthcare; and ‡Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah; §Kaiser-Permanente Southern California, Pasadena, California; ∥Homer Warner Center for Informatics Research, Intermountain Healthcare, Murray, Utah; ¶Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, Utah; and **Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah.
Cristina M
CM
Pratt
Eliotte L
EL
Hirshberg
Jason P
JP
Jones
Kathryn G
KG
Kuttler
Michael J
MJ
Lanspa
Emily L
EL
Wilson
Ramona O
RO
Hopkins
Samuel M
SM
Brown
D018806:APACHE; D000328:Adult; D000368:Aged; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D011379:Prognosis; D011594:Psychometrics; D011788:Quality of Life; D012189:Retrospective Studies; D012769:Shock / Q000175:diagnosis* / Q000401:mortality / Q000523:psychology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014589:Utah / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D009638:Norepinephrine