Sepsis Survivors Need Better Rehabilitation Care After Hospital Discharge

A pair of medical scientists has released new recommendations for post-hospital care for patients who survive from sepsis, which is a common cause of hospital readmission.

Sepsis is a life-threatening condition that can occur when the body has an extreme response to infection. According to the Centers for Disease Control and Prevention (CDC), the 4 types of infections often related to sepsis are of the lung (pneumonia), kidney (urinary tract infection), skin, and gut. While anyone can get sepsis, infants, children, the elderly, and individuals with medical issues such as cancer and diabetes are at highest risk. Without rapid treatment, sepsis can progress rapidly and lead to tissue damage, organ failure, and death. Sepsis is causing an increasing toll on mortality rates and health care costs in hospitals in the United States, where there are more than 1.5 million cases of these infections each year. In fact, a 2014 study in The Journal of the American Medical Association found that sepsis contributes to 1 in every 2 to 3 hospital deaths, making it the leading cause of death in US hospitals.

Sepsis can be difficult to diagnose as it can mimic other conditions. Once a doctor makes a sepsis diagnosis, a rapid medical response is key to successful treatment, which includes administering intravenous antibiotics to stop the infection and oxygen to maintain blood flow to the organs. According to a new review recently published in the Journal of the American Medical Association, while advances have been made in sepsis treatment and survival, better post-sepsis care is needed to prevent re-hospitalization and treat the long-term effects that can occur from these dangerous infections.

The authors, a pair of medical scientists from the University of Michigan and the University of Pittsburgh School of Medicine, write that hospital readmission rates remain high among sepsis survivors; about 40% of patients who have recovered from sepsis are re-hospitalized within 90 days of discharge. Of the more than 19 million individuals who develop sepsis each year globally, 14 million survive, but too often they suffer from impairments and long-term effects caused by the condition. In fact, among sepsis survivors, half recover, one-third die during the following year, and one-sixth go on to develop severe persistent impairments. These impairments include the inability to bathe or dress independently, a 3-fold increase in the prevalence of moderate to severe cognitive impairment, and a high prevalence of mental health problems that include anxiety, depression, or posttraumatic stress disorder.

“Current treatment guidelines emphasize interventions that reduce short-term mortality, but with little information on strategies to minimize physical disability, cognitive impairment or health deterioration after sepsis,” said senior author Derek Angus, MD, MPH, in a recent press release from the University of Pittsburgh’s Schools of the Health Sciences. “We need to focus not only on saving the patient’s life, but also on ensuring the patient will have the best possible quality of life after leaving the hospital.”

Following a review of medical literature on sepsis survivorship, the authors recommend a combination of high-quality early care, post-discharge assessment and treatment including speech therapy and physical and occupational rehabilitation, and screening for pre-existing conditions that may increase the likelihood of developing post-sepsis complications. "While we are making these recommendations based on available research, many important questions about post-sepsis morbidity remain unanswered," said lead author Hallie C. Prescott, MD, MSc. "Future research is needed to better characterize how pre-sepsis health affects long-term outcomes after sepsis so we can best tailor treatment and long-term recovery to the patient."