Quality of Life and Functional Recovery After Intensive Care for Sepsis

• In Sepsis
• Tue, 15 Jul 2025

Many ICU survivors of sepsis do not fully regain health or normal function, facing issues in cognition, physical, and mental health (post-sepsis syndrome). Recovery, not just survival, is crucial to patients and families, but studies show increased healthcare use post-ICU, indicating incomplete recovery. Health, per WHO, includes physical, mental, and social well-being, with quality of life (QoL) and health-related quality of life (HRQoL) as key measures, along with the ability to work.

Smaller studies report decreased HRQoL in sepsis ICU survivors with gradual improvement, but no national cohort studies have tracked HRQoL changes over time or related factors. In Sweden, HRQoL (via RAND-36) and return to work (supported by universal sick leave systems) provide measures of functional recovery.

A recent study aimed to compare HRQoL in ICU-treated sepsis patients with matched controls and assess functional recovery versus ICU patients without sepsis. It also sought to identify risk factors for poor recovery, hypothesising that ICU-treated sepsis leads to prolonged functional loss influenced by pre-existing illnesses and disease severity, using HRQoL and work incapacity as outcome measures.

The study included all adult ICU patients with sepsis in Sweden (2008–2020). The primary outcome was HRQoL measured by RAND-36 after ICU discharge. For working-age patients, sick-leave data were collected to assess work incapacity.

RAND-36 scores from 14,006 sepsis ICU survivors were lower than the general Swedish population. Males scored higher, and age showed mixed effects. Pre-ICU comorbidities linked to lower scores, while illness severity mainly affected general health. Invasive ventilation correlated with higher scores, but renal replacement therapy and longer ICU stays related to lower scores. RAND-36 improved over time post-ICU. Longer sick leave was linked to lower RAND-36, with many patients already on sick leave before ICU, indicating pre-existing vulnerability. Sick leave increased after sepsis and did not fully return to baseline. Lower education, female sex, and comorbidities were risk factors for poor recovery.

This study found that ICU-treated sepsis survivors do not regain population-level HRQoL within 15 months, and working-age patients show incomplete functional recovery, with return to work rates remaining low even at 24 months. Poor recovery was linked primarily to patient-related factors like pre-existing comorbidities, sex, age, and socioeconomic status, rather than severity of the acute illness or ICU treatments.

Sepsis survivors had markedly reduced HRQoL compared to the general population, with some improvement over time but high individual variability in recovery trajectories. Many patients had increased sick leave even before ICU admission, reflecting underlying vulnerability and deteriorating health prior to sepsis. After ICU, sick leave increased further and only partially improved, with factors such as higher education linked to faster return to work.

Demographics (female sex, older age) and comorbidities (cerebrovascular disease, COPD, neurological and psychiatric disorders) were strongly associated with worse HRQoL and prolonged work incapacity. Acute illness severity and ICU interventions had limited impact on long-term HRQoL, highlighting that chronic health status and functional reserve play a greater role in post-sepsis recovery than the acute episode itself.

The significantly reduced and variable HRQoL and functional recovery in ICU-treated sepsis patients highlight the need for greater focus and personalised care from healthcare and society, especially for women, those with comorbidities, and patients with long ICU stays. Illness severity and ICU treatment factors poorly predict long-term HRQoL and should not guide recovery discussions. Increased work incapacity before ICU suggests opportunities for early interventions to prevent sepsis. The findings support the need for tailored multidisciplinary rehabilitation programmes for sepsis survivors.

Post-ICU recovery and HRQoL interventions should prioritise patients with comorbidities and longer ICU stays rather than those with higher illness severity at admission. Additionally, sepsis prevention efforts could effectively target patients already on sick leave as a vulnerable group.

Source: Intensive Care Medicine
Image Credit: iStock 

References:

Halvorsen P, Marks-Hultström M, Wallin E et al. (2025) Health-related quality of life and functional recovery after intensive care for sepsis in a national cohort. Intensive Care Med.