cepia

Clinical Epidemiology and Ageing

Long-term quality of life in adult patients surviving purpura fulminans: an exposed-unexposed multicenter cohort study.

Contou D, Canoui-Poitrine F, Coudroy R, Préau S, Cour M, Barbier F, Terzi N, Schnell G, Galbois A, Zafrani L, Zuber B, Ehrmann S, Gelisse E, Colling D, Schmidt M, Jaber S, Conia A, Sonneville R, Colin G, Guérin L, Roux D, Jochmans S, Kentish-Barnes N, Audureau E, Layese R, Alves A, Ouedraogo R, Brun-Buisson C, Dessap AMekontso, de Prost N Clin Infect Dis. 2018.

Background: Long-term Health-related Quality of Life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated.

Methods: A French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 ICUs for a PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, SAPS II and gender with septic shock survivors (unexposed group). HR-QOL was assessed during a phone-interview using the SF-36 questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale-Revised (IES-R) and the Activity of Daily Living (ADL) and Instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire.

Results: Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 [35-83] and 44 [35-72] months of ICU discharge, respectively (p=0.23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median [quartile1-quartile3]=47 [36-53] vs. 54 [36-57]; p=0.18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n=12/37, 32%) exhibited lower PCS (34 [24-38] vs. 52 [42-56]; p=0.001) and IADL scores (7 [4-8] vs. 8 [7-8]; p=0.021) as compared to non-amputated patients.

Conclusion: Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health.

Clinical Trials: NCT03216577.

DOI: 10.1093/cid/ciy901

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