%0 Journal Article %J Am J Geriatr Psychiatry %D 2013 %T Symptoms of depression in survivors of severe sepsis: a prospective cohort study of older Americans. %A Dimitry S Davydow %A Catherine L Hough %A Kenneth M. Langa %A Theodore J Iwashyna %K Aged %K Aged, 80 and over %K Cohort Studies %K depression %K Female %K Hospitalization %K Humans %K Longitudinal Studies %K Male %K Poisson Distribution %K Prospective Studies %K Regression Analysis %K Risk Factors %K Sepsis %K Severity of Illness Index %K Survivors %K United States %X

OBJECTIVES: To examine if incident severe sepsis is associated with increased risk of subsequent depressive symptoms and to assess which patient characteristics are associated with increased risk of depressive symptoms.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of older U.S. adults interviewed as part of the Health and Retirement Study (1998-2006).

PARTICIPANTS: A total of 439 patients who survived 471 hospitalizations for severe sepsis and completed at least one follow-up interview.

MEASUREMENTS: Depressive symptoms were assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. Severe sepsis was identified using a validated algorithm in Medicare claims.

RESULTS: The point prevalence of substantial depressive symptoms was 28% at a median of 1.2 years before sepsis, and remained 28% at a median of 0.9 years after sepsis. Neither incident severe sepsis (relative risk [RR]: 1.00; 95% confidence interval [CI]: 0.73, 1.34) nor severe sepsis-related clinical characteristics were significantly associated with subsequent depressive symptoms. These results were robust to potential threats from missing data or alternative outcome definitions. After adjustment, presepsis substantial depressive symptoms (RR: 2.20; 95% CI: 1.66, 2.90) and worse postsepsis functional impairment (RR: 1.08 per new limitation; 95% CI: 1.03, 1.13) were independently associated with substantial depressive symptoms after sepsis.

CONCLUSIONS: The prevalence of substantial depressive symptoms in severe sepsis survivors is high but is not increased relative to their presepsis levels. Identifying this large subset of severe sepsis survivors at increased risk for major depression, and beginning interventions before hospital discharge, may improve outcomes.

%B Am J Geriatr Psychiatry %I 21 %V 21 %P 887-97 %8 2013 Sep %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/23567391?dopt=Abstract %2 PMC3462893 %4 Critical care/Depression/Outcome assessment (healthcare)/Sepsis/health Care Utilization/HOSPITALIZATION %$ 69138 %R 10.1016/j.jagp.2013.01.017 %0 Journal Article %J Am J Respir Crit Care Med %D 2012 %T Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions. %A Theodore J Iwashyna %A Netzer, Giora %A Kenneth M. Langa %A Christine T Cigolle %K Aged %K Aged, 80 and over %K Body Mass Index %K Chronic pain %K Cohort Studies %K Comorbidity %K Critical Illness %K Disabled Persons %K disease progression %K Female %K Geriatric Assessment %K Hearing Disorders %K Hospitalization %K Humans %K Incidence %K Male %K Musculoskeletal Diseases %K Prognosis %K Retrospective Studies %K Risk Assessment %K Sepsis %K Survival Analysis %K Survivors %K Thinness %K Time %K Treatment Outcome %K Urinary incontinence %K Vision Disorders %X

RATIONALE: Survivors of critical illness suffer significant limitations and disabilities.

OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.

METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory.

MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.

CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.

%B Am J Respir Crit Care Med %I 185 %V 185 %P 835-41 %8 2012 Apr 15 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/22323301?dopt=Abstract %2 PMC3360570 %4 Body Mass Index/Cohort Studies/Comorbidity/DISABILITY/DISABILITY/Geriatric Assessment/Hearing Disorders/Hospitalization/Musculoskeletal Diseases/Risk Assessment/Sepsis/Survival Analysis/body Weight/Treatment Outcome/Urinary Incontinence/Vision Disorders %$ 69456 %R 10.1164/rccm.201109-1660OC