Objectives: 

To evaluate the physical and psychosocial domains of health-related quality of life among children during the first year following community-acquired septic shock, and explore factors associated with poor physical and psychosocial health-related quality of life outcomes.

Design: 

Secondary analysis of the Life After Pediatric Sepsis Evaluation.

Setting: 

Twelve academic PICUs in the United States.

Patients: 

Children greater than or equal to 1 month and less than 18 years old who were perceived to be without severe developmental disability by their family caregiver at baseline and who survived hospitalization for community-acquired septic shock.

Interventions: 

Family caregivers completed the Pediatric Quality of Life Inventory for children 2–18 years old or the Pediatric Quality of Life Inventory Infant Scales for children less than 2 years old at baseline (reflecting preadmission status), day 7, and months 1, 3, 6, and 12 following PICU admission. Higher Pediatric Quality of Life Inventory Physical and Psychosocial Health Summary Scores indicate better health-related quality of life.

Measurements and Main Results: 

Of 204 children, 58 (28.2%) had a complex chronic comorbid condition. Children with complex chronic comorbid conditions had lower baseline physical health-related quality of life (62.7 ± 22.6 vs 84.1 ± 19.7; p < 0.001) and psychosocial health-related quality of life (68.4 ± 14.1 vs 81.2 ± 15.3; p < 0.001) than reference norms, whereas children without such conditions had baseline scores similar to reference norms. Children with complex chronic comorbid conditions recovered to their baseline health-related quality of life, whereas children without such conditions did not (physical health-related quality of life 75.3 ± 23.7 vs 83.2 ± 20.1; p = 0.008 and psychosocial health-related quality of life 74.5 ± 18.7 vs 80.5 ± 17.9; p = 0.006). Age less than 2 years was independently associated with higher month 12 physical health-related quality of life, and abnormal neurologic examination and neurologic injury suspected by a healthcare provider during the PICU course were independently associated with lower month 12 physical health-related quality of life. Treatment of increased intracranial pressure and medical device use at month 1 were independently associated with lower month 12 psychosocial health-related quality of life.

Conclusions: 

Physical and psychosocial health-related quality of life were reduced among children during the first year following community-acquired septic shock compared with reference norms, although many recovered to baseline. Risk factors for poor health-related quality of life included neurologic complications during the hospitalization and dependence on a medical device 1 month postadmission.

中文翻译：

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小儿社区获得性感染性休克后与身心健康相关的生活质量改变的轨迹和风险因素*

目标： 

在社区获得性败血性休克后的第一年，评估儿童健康相关生活质量的身体和心理社会领域，并探讨与身体和心理健康相关的生活质量差的相关因素。

设计： 

小儿 败血症评估后生活的二级分析。

设置： 

美国有十二个学术性PIC​​U。

耐心： 

大于或等于1个月且小于18岁的儿童在基线时被家庭护理人员认为没有严重的发育障碍，并且因社区获得性败血性休克而住院治疗。

干预措施： 

家庭照顾者完成了儿科生活质量库存为孩子2-18岁的儿童生活质量的库存婴儿秤的孩子不到2年的基线岁（反映住院前的状态），7天，1个月，3，6 ，以及PICU入学后的12。较高的儿科生活质量清单身心健康摘要得分表明与健康相关的生活质量更好。

测量和主要结果： 

在204名儿童中，有58名（28.2％）患有复杂的慢性合并症。患有复杂慢性合并症的儿童的基线身体健康相关的生活质量较低（62.7±22.6 vs 84.1±19.7; p <0.001）和社会心理健康相关的生活质量（68.4±14.1 vs 81.2±15.3; p <0.001）相比参考规范，没有这种条件的儿童的基线得分与参考规范相似。患有复杂慢性合并症的儿童可恢复至与健康相关的基本生活质量，而没有此类疾病的儿童则无法恢复（与身体健康相关的生活质量）75.3±23.7和83.2±20.1; p = 0.008，与心理社会健康相关的生活质量为74.5±18.7和80.5±17.9；p = 0.006）。小于2岁的年龄与12个月以上与身体健康相关的生活质量独立相关，而医疗服务提供者怀疑在PICU过程中异常的神经系统检查和神经系统损伤与12个月以下与身体健康相关的生活质量独立相关。第1个月颅内压升高的治疗和医疗器械的使用与第12个月心理社会健康相关的生活质量较低相关。

结论： 

与参考标准相比，社区获得性败血性休克后第一年儿童的与身心健康有关的生活质量有所降低，尽管许多人已恢复至基线水平。与健康相关的生活质量较差的风险因素包括住院期间的神经系统并发症以及入院后1个月对医疗设备的依赖。