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Enhancing Recovery From Sepsis: A Review
Open accessAbstract
Importance: Survival from sepsis has improved in recent years, resulting in an increasing number of patients who have survived sepsis treatment. Current sepsis guidelines do not provide guidance on posthospital care or recovery. Observations: Each year, more than 19 million individuals develop sepsis, defined as a life-threatening acute organ dysfunction secondary to infection. Approximately 14 million survive to hospital discharge and their prognosis varies. Half of patients recover, one-third die during the following year, and one-sixth have severe persistent impairments. Impairments include development of an average of 1 to 2 new functional limitations (eg, inability to bathe or dress independently), a 3-fold increase in prevalence of moderate to severe cognitive impairment (from 6.1% before hospitalization to 16.7% after hospitalization), and a high prevalence of mental health problems, including anxiety (32% of patients who survive), depression (29%), or posttraumatic stress disorder (44%). About 40% of patients are rehospitalized within 90 days of discharge, often for conditions that are potentially treatable in the outpatient setting, such as infection (11.9%) and exacerbation of heart failure (5.5%). Compared with patients hospitalized for other diagnoses, those who survive sepsis (11.9%) are at increased risk of recurrent infection than matched patients (8.0%) matched patients (P < .001), acute renal failure (3.3% vs 1.2%, P < .001), and new cardiovascular events (adjusted hazard ratio [HR] range, 1.1-1.4). Reasons for deterioration of health after sepsis are multifactorial and include accelerated progression of preexisting chronic conditions, residual organ damage, and impaired immune function. Characteristics associated with complications after hospital discharge for sepsis treatment are not fully understood but include both poorer presepsis health status, characteristics of the acute septic episode (eg, severity of infection, host response to infection), and quality of hospital treatment (eg, timeliness of initial sepsis care, avoidance of treatment-related harms). Although there is a paucity of clinical trial evidence to support specific postdischarge rehabilitation treatment, experts recommend referral to physical therapy to improve exercise capacity, strength, and independent completion of activities of daily living. This recommendation is supported by an observational study involving 30 000 sepsis survivors that found that referral to rehabilitation within 90 days was associated with lower risk of 10-year mortality compared with propensity-matched controls (adjusted HR, 0.94; 95% CI, 0.92-0.97, P < .001). Conclusions and Relevance: In the months after hospital discharge for sepsis, management should focus on (1) identifying new physical, mental, and cognitive problems and referring for appropriate treatment, (2) reviewing and adjusting long-term medications, and (3) evaluating for treatable conditions that commonly result in hospitalization, such as infection, heart failure, renal failure, and aspiration. For patients with poor or declining health prior to sepsis who experience further deterioration after sepsis, it may be appropriate to focus on palliation of symptoms.
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“Around 15% develop one to two significant functional limitations, cognitive impairments, or mental health conditions”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Prescott & Angus, 2018
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Nearly 60% of all people released from hospitals after sepsis are readmitted within the year. Approximately 40% die within 2 years, 80% within 5 years”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Prescott & Angus, 2018
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Additionally, living in neighborhoods with low SES is associated with an increased risk of sepsis (575), community-acquired bacteremia (575) and death from bacteremia (576) and worse outcomes (577).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [577]
Experimental — accuracy not yet measuredIn the citing paper
“Almost 40% of sepsis survivors are re-hospitalised within 3 months, often for preventable conditions [580], contributing to increased healthcare costs [581].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [580]
In the citing paper
“In addition, sepsis survivors are at increased risk for recurrent infection, AKI and new cardiovascular events compared to patients hospitalised for other diagnoses [580].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [580]
In the citing paper
“There are a growing number of online resources and informational brochures regarding “post intensive care” / “post-sepsis syndrome”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [580]
In the citing paper
“Nonetheless, based on their strong rationale, and benefit in related populations [580] (e.g., older patients with cognitive impairment, patients following stroke or traumatic brain injury), we suggest referral to rehabilitation programmes in survivors of sepsis.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [580]
In the citing paper
“Clinical studies have shown that the incidence of moderate-to-severe cognitive impairment in patients who survive severe sepsis is as high as 70% (Prescott & Angus, 2018).”
From The modulatory effects of gut microbes and metabolites on blood-brain barrier integrity and brain function in sepsis-associated encephalopathy (2023) · cites this paper as Prescott & Angus, 2018
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“Possibly, the burden carried by formerly septic patients is less appreciated outside the intensive care community and / or the logistics of transfer from an ICU to rehabilitation care does not work properly [30, 32].”
BackgroundKey Components of ICU Recovery Programs: What Did Patients Report Provided Benefit?
McPeake, J. M., Boehm, L. M., Hibbert, E., Bakhru, R. N., Bastin, A. J., Butcher, B. W., Eaton, T. L., Harris, W., Hope, A. A., Jackson, J. C., et al. (2020) · Critical Care Explorations · doi:10.1097/cce.0000000000000088 · Cited by 97
A crosstalk between gut and brain in sepsis-induced cognitive decline
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“Consequently, survival patients can experience long-term memory impairment, decreased concentration, verbal fluency, and executive function impairments after being discharged from the hospital [2].”
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“The intervention was designed to facilitate the delivery of best practice care for sepsis survivors including: 1) identification and treatment of new physical, mental, and cognitive deficits; 2) review and adjustment of medications; 3) surveillance of treatable conditions that commonly lead to poor outcomes, including…”
BackgroundMethodInfluentialEpidemiology and Predictors of 30-Day Readmission in Patients With Sepsis
Gadre, S. K., Shah, M. K., Mireles‐Cabodevila, E., Patel, B. D., & Duggal, A. (2019) · CHEST Journal · doi:10.1016/j.chest.2018.12.008 · Cited by 93
Research Progress on the Mechanism of Sepsis Induced Myocardial Injury
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Immune Functional Assays, From Custom to Standardized Tests for Precision Medicine
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“5 million cases per year with 6 million deaths and 3 million suffering from frequent hospital re-admission post-sepsis, and long-term morbidity (30, 31).”
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On behalf of FROG-ICU investigators, Gayat, É., Hollinger, A., Cariou, A., Deye, N., Vieillard‐Baron, A., Jaber, S., Chousterman, B. G., Lü, Q., Laterre, P., et al. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5160-6 · Cited by 90
“Acute kidney injury is associated with worse longterm outcome in many ICU studies [19].”
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Coopersmith, C. M., Antonelli, M. M., Bauer, S. R., Deutschman, C. S., Evans, L., Ferrer, R., Hellman, J., Jog, S., Kesecioğlu, J., Kissoon, N. “., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000004895 · Cited by 99
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Older Sepsis Survivors Suffer Persistent Disability Burden and Poor Long‐Term Survival
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Long-term impact of sepsis on cardiovascular health
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A New Effective Machine Learning Framework for Sepsis Diagnosis
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Sepsis prediction model for determining sepsis vs SIRS, qSOFA, and SOFA
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“There is also a considerable long-term morbidity and mortality risk; about one-third die in the year after sepsis, one-sixth experience severe persisting weakness, psychiatric or cognitive issues, and only half make a complete or near-complete recovery.(4) Inadequate organ perfusion with resultant tissue hypoxia repre…”
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Assessing clinical heterogeneity in sepsis through treatment patterns and machine learning
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Association between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis
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“30 (14) 17 (19) 58 (27) 20 (23) 6 (3) 4 (5) 45 (21) 15 (17) < 0.”
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“Most of times, the exercises are prescribed and supervised by physiotherapists [13,16,23 – 26] and exercise professionals.”
Understanding Post-Sepsis Syndrome: How Can Clinicians Help?
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“To estimate long-term sepsis outcomes and thereby predicting specific needs, pre-existing risk factors for poor long-term outcomes should be considered.(8) Important to realise is the difference in co-morbidities and frailty in individual patients pre-sepsis, but also the social aspects such as having spouses and a we…”
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“Although the in-hospital mortality of patients with sepsis has declined in recent years, rehospitalization, cognitive impairment, and physical disability after sepsis remain crucial issues that affect patients’ quality of life [40].”
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“Furthermore, physiotherapy within 90 days of hospitalization is associated with the risk of death 10 years later [88].”
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“Therefore, early detection and proper management of frailty, such as physical exercise and nutritional supplementation, are important for better prognosis in patients who are at risk of sepsis (44, 45).”
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“This organ system dysfunction is correlated with higher long term mortality, even if patients recover from their illness in the hospital [16].”
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“modulating the immunometabolism among patients undergone immunosuppression associated with sepsis or are dealing with immunosuppression even after recovering from sepsis [250].”
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“study suggested that physical rehabilitation following ICU discharge improves long-term mortality.(8) 9 A recent systematic review by Connolly et al(10) focused on randomised controlled trials (RCTs) regarding the effectiveness of enhanced exercise rehabilitation following ICU discharge in adult ICU survivors who had…”
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“However, it is unclear if such resulting sequelae impact rehospitalizations (9), warranting future studies to evaluate which in-hospital interventions are associated with in rehospitalizations for survivors of sepsis.”
Metadata
- Authors
- Prescott, H. C., & Angus, D. C.
- Affiliations
- University of Michigan (US)
- University of Pittsburgh (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2018-01-02
- Volume
- 319
- Issue
- 1
- Pages
- 62
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC5839473
- OpenAlex
- W2782135811
- Semantic Scholar
- 98cad261fafa6b5df5332a165d01f11de1afd48e
- Cited by
- 1,059
- References
- 93
- Citations by year
- 2026: 143 · 2025: 149 · 2024: 161 · 2023: 142 · 2022: 124 · 2021: 135 · 2020: 103 · 2019: 67 · 2018: 32
- FWCI
- 65.73
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of General Medical Sciences (R01GM097471, K08GM115859)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Nursing › Nutrition and Dietetics › Vitamin C and Antioxidants Research
- Keywords
- sepsis survivors, post-hospital care, post-discharge rehabilitation, physiotherapy referral, functional recovery, cognitive impairment, post-traumatic stress disorder, depression, anxiety, hospital readmission, recurrent infections, acute kidney injury, cardiovascular events, activities of daily living, sepsis severity, immune dysfunction, hospital quality of care, sepsis management guidelines
- MeSH terms
- Activities of Daily Living, Adult, Mental Disorders, Cognition Disorders, Hospitalization, Humans, Sepsis
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