Abstract
Survivors of sepsis are at high risk of developing post-intensive care syndrome (PICS), which encompasses physical, mental, and cognitive impairments after critical illness. Among these domains, physical and cognitive impairments have been linked to increased long-term mortality; however, their specific associations with mortality among patients with sepsis remain unclear. This study aimed to examine the relationship between PICS and subsequent survival, with a particular focus on physical and cognitive domains. In this retrospective cohort study, we included patients with sepsis who were admitted to the intensive care unit (ICU) for ≥ 48 hours between 2014 and 2021. Demographic and clinical data from admission, physical and cognitive impairments 1 month after ICU discharge; and 1-year survival were obtained from electronic medical records. Binary logistic regression analyses were performed to identify independent risk factors for the development of the physical and/or cognitive components of the PICS and for each individual domain. Cox proportional hazards models were used to determine the independent factors associated with 1-year mortality. Among the 210 eligible patients, 99 (47%) developed the physical and/or cognitive components of PICS, and 43 (20%) died within 1 year after ICU discharge. Physical impairment was present in 96 patients (45%) and cognitive impairment in 59 patients (28%). In the logistic regression analysis adjusted for covariates, increasing age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.09; P < .001), longer ICU stay (OR 1.09, 95% CI 1.01-1.17; P = .031), and prolonged delirium (OR 1.41, 95% CI 1.19-1.67; P < .001) were independently associated with the development of physical and/or cognitive components of PICS. In multivariable Cox analyses, the presence of these components was independently associated with higher 1-year mortality (hazard ratio 1.51, 95% CI 1.06-2.15; P = .021). When analyzed separately, physical impairment was associated with increased 1-year mortality, whereas cognitive impairment was not. Increasing age, prolonged delirium during ICU stay, and longer ICU stay were independently associated with the development of the physical and/or cognitive components of PICS. Among sepsis survivors evaluated at 1 month after ICU discharge, the presence of these components (particularly physical impairment) was independently associated with increased 1-year mortality.