• Naomi E Hammond, Simon R Finfer, Qiang Li, Colman Taylor, Jeremy Cohen, Yaseen Arabi, Rinaldo Bellomo, Laurent Billot, Meg Harward, Christopher Joyce, Colin McArthur, John Myburgh, Anders Perner, Dorrilyn Rajbhandari, Andrew Rhodes, Kelly Thompson, Steve Webb, Balasubramanian Venkatesh, and ADRENAL Trial Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group.
• Statistics Division, The George Institute for Global Health, UNSW Sydney, Newtown, Australia. nhammond@georgeinstitute.org.au.
• Intensive Care Med. 2020 Sep 1; 46 (9): 1696-1706.

PurposeTo 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.MethodsUsing 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.ResultsAt 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.ConclusionsApproximately 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.

16 keywords...

hide…