Subsequent infections in survivors of sepsis: epidemiology and outcomes.

PURPOSE: Sepsis is a devastating condition with considerable mortality. The causes of long-term mortality are poorly understood. To test the hypothesis that patients with sepsis are more susceptible to recurrent infections and death due to infectious complications, we investigated the outcomes of patients who survived sepsis, with regard to the incidence of recurrent infections and mortality. MATERIALS AND METHODS: A retrospective study of the patients admitted to the intensive care unit (ICU) for sepsis from 2001 to 2002 who achieved 30-day survival (sepsis survivors [SSs], N = 78) and a control group of patients admitted to the ICU for noninfectious conditions with a similar severity of illness (N = 50) was performed. The primary end point was the number of recurrent infections in the first year posthospitalization. RESULTS: The SSs group had higher rates of infections following hospital discharge compared to controls. Using a multivariable model, having survived sepsis was the strongest predictor of the development of subsequent infections (rate ratio [RR]: 2.83, P= .0006), the need for rehospitalization for infection in the year after the initial hospitalization (RR: 3.78, P = .0009), and postdischarge mortality (hazard ratio = 3.61, P = .003). CONCLUSIONS: Critically ill patients who survive sepsis have an increased risk of recurrent infections in the year following their septic episode that is associated with increased mortality.

Association of chronic cough and pulmonary function with 6-minute walk test performance in HIV infection.

OBJECTIVE: Chronic lung disease has been associated with greater impairment in self-reported physical function in HIV-infected patients. We sought to study this association using objective measures of physical function and pulmonary function. DESIGN: Baseline data from the Examinations of HIV Associated Lung Emphysema study, a multicenter observational cohort of HIV-infected and uninfected veterans. METHODS: We assessed the association between clinical, laboratory, and pulmonary function measures with 6-minute walk test (6-MWT). Multivariable linear regression models were generated to identify factors associated with 6-MWT performance. RESULTS: Three hundred forty participants completed 6-MWT (mean age 55 years), with 68% blacks, 94% men, and 62% current smokers. Overall, 180 (53%) were HIV-infected and 63 (19%) had spirometry-defined chronic obstructive pulmonary disease. In a multivariable model, age, current smoking, and obesity (body mass index > 30) were independently associated with lower 6-MWT performance, but HIV infection was not; there was a significant interaction between HIV and chronic cough, such that distance walked among HIV-infected participants with chronic cough was 51.76 m less (P = 0.04) compared with those without cough or HIV. Among HIV-infected participants, the forced expiratory volume in 1 second (FEV1, percent predicted), to a greater extent than total lung capacity or diffusing capacity, attenuated the association with chronic cough; decreased FEV1 was independently associated with lower 6-MWT performance in those with HIV. CONCLUSIONS: Older age, current smoking, and airflow limitation were important determinants of 6-MWT performance in the HIV-infected participants. These findings suggest that potential interventions to improve physical function may include early management of respiratory symptoms and airflow limitation.

Usefulness of the human activity profile, a functional performance measure, in people with chronic obstructive pulmonary disease.

PURPOSE: To further evaluate the usefulness of the Human Activity Profile (HAP) as a functional performance measure for those with chronic obstructive pulmonary disease (COPD). METHODS: Phase 1. The sample consisted of 53 outpatients (51 male) with stable COPD (forced expiratory volume in 1 second% predicted (FEV1% pred) = 38 +/- 14 (mean +/- standard deviation) at a university-affiliated veterans affairs medical center. Variables were functional performance (HAP Maximal Activity Score [MAS], HAP Adjusted Activity Score [AAS]), dyspnea (modified Borg category-ratio scale and Shortness of Breath Questionnaire [SOBQ]), and exercise capacity (6-minute walk distance [6MWD]). Phase 2. The HAP was administered pre-post pulmonary rehabilitation in 48 (14 male) outpatients with stable COPD (FEV1% pred = 35 +/- 15) at an outpatient pulmonary rehabilitation program at a large private hospital. RESULTS: Phase 1. Scores for MAS and AAS were, respectively, 62 +/- 12 and 44 +/- 15. The 6MWD, modified Borg, and SOBQ were, respectively, 1055 +/- 372 ft, 4.1 +/- 1, and 64.4 +/- 22 ft. Correlations of the 6MWD and dyspnea scores with the AAS were strong and explained 40% of the AAS variation. Phase 2. The baseline MAS and AAS scores were 55 +/- 14 and 42 +/- 15, respectively, with 29/48 (60%) classified as "low fitness" on the basis of the AAS. Post-rehabilitation, there was significant improvement in the AAS score (48 +/- 13) and significant reduction for those classified as "low fitness." CONCLUSIONS: The utility of the HAP as a measure of functional performance improvement in COPD is supported by its relationship with both 6MWD and dyspnea and its responsiveness to pulmonary rehabilitation.