Cited by 1,059Sepsis Diagnosis and TreatmentIntensive Care Unit Cognitive DisordersVitamin C and Antioxidants Research

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Enhancing Recovery From Sepsis: A Review

Open access

Prescott, Hallie C., Angus, Derek C.·2018·JAMA

DOI 10.1001/jama.2017.17687PMC PMC5839473

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Abstract

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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Background
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Background
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“…of being able to return to work, to participate in social and family activities, and to experience an overall diminished health-related quality of life (Iwashyna et al., 2010; Lazosky et al., 2010; Prescott and Angus, 2018; König et al., 2019; Prescott et al., 2019; Stallmach et al., 2022).”
Background
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Background
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Background
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BackgroundInfluential
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Method
Maternal sepsis update
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“caused by a dysregulated host response to infection [1], is one of the most common medical emergencies and affects approximately 19 million people worldwide each year [2].”
Background
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Background
Hyaluronan with Different Molecular Weights Can Affect the Gut Microbiota and Pathogenetic Progression of Post-Intensive Care Syndrome Mice in Different Ways
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Andersen, S. K., Herridge, M., & Fiest, K. M. (2024) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0044-1787993 · Cited by 5
“27 The number and type of preexisting comorbidities can affect the risk of requiring long-term organ support: patients with ﬁ ve or more comorbidities have increased odds of new dialysis (OR: 4.9), chronic care (OR: 3.2), and long-term respiratory support (OR: 2.7), compared with those with four or…”
BackgroundInfluential
Fisiología del envejecimiento: Actualización y perspectiva genética
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Application and value of hydrogen sulfide modulated autophagy in sepsis
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Authors: Prescott, H. C., & Angus, D. C.
Affiliations: University of Michigan (US)
University of Pittsburgh (US)
ORCID: Prescott, Hallie C.
Angus, Derek C.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2018-01-02
Volume: 319
Issue: 1
Pages: 62
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2017.17687
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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