Objectives: Long-term outcomes after sepsis survival remain poor. No clinical laboratory tests are in use for stratifying long-term risk after sepsis, limiting the development of secondary prevention. The peripheral blood neutrophil:lymphocyte ratio (NLR) reflects innate and adaptive immune cell balance, and may reflect an immune milieu which is associated with long-term risk after sepsis. Accordingly, we evaluated the association between the NLR in the weeks after sepsis hospitalization discharge—a time when patients are routinely seen in post-ICU clinics—and long-term outcomes. Design: Population-based cohort study. Setting: Ontario, Canada, 2010–2020. Patients: Adults discharged alive from a sepsis hospitalization. Interventions: None. Measurements and Main Results: The exposure was the first outpatient NLR—derived from the complete blood count—measured 15–90 days after sepsis discharge. Among 37,250 survivors with available NLR, the median (interquartile range [IQR]) time-to-measurement was 34 days (22–54 d), and the median NLR was 2.7 (1.8–4.2). Within 1 year, 17,732 patients (47.6%) were rehospitalized or died (median [IQR] time-to-event, 82 d [27–185 d]). The frequency of rehospitalization or death increased across increasing NLR quartiles: 34.2%, 41.5%, 50.3%, and 64.4% ( p trend < 0.001). Compared with the lowest quartile, adjusted hazard ratios (95% CI) were 1.24 (1.18–1.29), 1.54 (1.48–1.62), and 2.25 (2.15–2.35) across higher quartiles. For most patients, NLR after sepsis returned to its patient-specific presepsis ambient level, which was itself prognostic. Conclusions: Among sepsis survivors, outpatient NLR measured 15–90 days after discharge is strongly associated with 1-year risk of rehospitalization or death. As a simple, widely available biomarker, the NLR may support early postsepsis risk stratification and inform development of secondary prevention strategies.
Objectives: To evaluate long-term mortality among sepsis survivors in Catalonia over a 15-year period and to identify factors associated with increased mortality within 2 years after hospital discharge. Design: Retrospective population-based cohort study. Setting: Acute-care hospitals in Catalonia, Spain. Patients: Adult and pediatric patients hospitalized with sepsis between 2005 and 2019 identified using the International Classification of Diseases , 9th Revision, Clinical Modification and International Classification of Diseases , 10th Revision, Clinical Modification codes for infection and acute organ dysfunction. Patients who died during hospitalization, were transferred to another facility, or represented readmission episodes were excluded. Interventions: None. Measurements and Main Results: Data were obtained from the Catalan Minimum Basic Dataset of Acute-Care Hospitals, with longitudinal follow-up through the Central Registry of Insured Persons. Comorbidities were assessed using the Charlson comorbidity index. Logistic regression and Cox proportional hazards models were used to identify predictors of long-term mortality. Among 296,554 hospital admissions for sepsis, 237,075 patients (79.9%) survived to hospital discharge. Of these, 42% died (99,571) within 2 years. Long-term mortality increased significantly with age, ranging from 5.8% in patients younger than 15 years to 62% in those older than 84 years ( p < 0.0001), and with comorbidity burden (21%, 38%, 51%, and 67% for Charlson index 0, 1–2, 3–4, and ≥ 5, respectively; p < 0.0001). Neoplasia (hazard ratio [HR], 2.011), liver cirrhosis (HR, 1.562), and dementia (HR, 1.304) were the comorbidities most strongly associated with mortality. Longer hospital stays were also associated with increased mortality. A progressive decline in long-term mortality was observed during 2017–2019. Conclusions: Long-term mortality among sepsis survivors remains high, with more than 40% dying within 2 years after hospital discharge. These findings support the need for structured post-sepsis care strategies focused on high-risk patients, improved continuity of care, and prevention of long-term sepsis-related complications.
Objectives: To develop and validate a shorter Family Satisfaction in the ICU (FS-ICU) questionnaire that reduces survey length while preserving content and psychometric performance for quality improvement and benchmarking. The FS-ICU survey assesses family perceptions of care, communication, and decision-making and has been translated into multiple languages with implementation across diverse health care systems internationally. In a province-wide electronic implementation in Ontario, more than 40% of initiated surveys were incomplete, suggesting that survey length may limit practicality for large-scale quality improvement and benchmarking. Design: Multistage study using provincial FS-ICU survey data and an independent multicenter validation dataset for item reduction, psychometric evaluation, agreement testing, and external validation of a shortened questionnaire. Setting: A 12-member expert working group, convened for a Critical Care Services Ontario initiative, used provincial web-based data from adult ICUs across Ontario to develop a shorter version, FS-ICUshort. External validation was applied to FS-ICUshort using a separate multicenter Canadian revised FS-ICU dataset. Participants: A 12-member expert working group led by Dr. Daren K. Heyland, including administrative staff, ICU clinical staff, patient experience specialists, and quality improvement specialists from Ontario, used provincial FS-ICU rollout data. Interventions: None. Measurements and Main Results: Using empirical criteria and expert ratings, the FS-ICU was reduced from 29 to 12 items: seven in the satisfaction-with-care domain (FS-Care) and five in the communication and decision-making domain (FS-DM). FS-ICUshort showed high internal consistency (Cronbach’s α = 0.93 for FS-Care, 0.86 for FS-DM, and 0.94 for total). Confirmatory factor analysis supported a two-factor structure with better fit than a single-factor model. Scores from FS-ICUshort closely matched full FS-ICU, with mean differences less than or equal to 1.1 points on a 0–100 scale and intraclass correlations of 0.97–0.99. External validation replicated these results. Conclusions: The 12-item FS-ICUshort maintains the core content and psychometric quality of the original FS-ICU while significantly reducing length, supporting routine use in ICU family experience measurement and benchmarking.
