In Germany about 90,000 patients survive sepsis per year. Few data are available indicating quality of life and chronic pain states of sepsis long-term survivors .
One hundred and fifty-two patients were approached who survived severe sepsis or septic shock (ACCP/SCCM) on our ICU. In order to obtain specific information about chronic pain states, these patients received the SF 36 as well as the Brief Pain Inventory (BPI) questionnaire, an instrument asking for different aspects of pain intensity and pain-associated functional interference. Data are presented as the mean ± SD. The norm scores of the SF 36 on subtest levels were compared with the scores of our sample. For statistical analysis t tests have been used. P < 0.05 was considered statistically significant.
Sixty-four patients, 43 males and 21 females, returned the questionnaires. The mean age was 62 ± 15 years. SF 36 items concerning bodily pain occurred in septic survivors significantly more frequently compared with the healthy normal population (49.4 ± 29.9; norm: 79.1 ± 27.4; P < 0.0001). In most of the BPI items, patients scored over 3 on an 11-step numeric rating scale (0 = no pain, 10 = worst possible pain). This limit is thought to differentiate between low pain on one side and the need for treatment on the other. For example, 44% of the patients reported a maximal NRS value of 0–3, but 56% a maximal value of 4–10 (mean: 4.1 ± 3.4). Mean values of pain-associated functional interference ratings were (0 = no interference, 10 = worst possible interference): general activity: 4.2 ± 3.1; mood: 3.4 ± 3.0; walking ability: 4.5 ± 3.5; work: 5.1 ± 3.5; relationship: 3.1 ± 3.1; sleep: 3.7 ± 3.0; enjoyment of life: 3.7 ± 3.1.
Differences in quality of life were previously evaluated in adult survivors of critical illness investigating general ICU populations compared with healthy controls . We focused on chronic pain states in patients who survived severe sepsis or septic shock. Here, we found highly significant differences in the pain-associated domain of SF 36 between survivors of severe sepsis or septic shock compared with the German healthy population. Furthermore, the interference due to pain was revealed to be high in septic survivors. Underlying reasons remain unclear and need to be evaluated. One potential contributing factor may be the proinflammatory cytokine response in sepsis that has been shown to increase pain in experimental settings.
In conclusion, we could reveal that quality of life in long-term survivors of severe sepsis or septic shock was impaired in comparison with the German healthy population. For the first time, we demonstrated additionally a higher incidence of pain in these patients.