Prediction model for quality of life in sepsis survivors one year after discharge

doi:10.5847/wjem.j.1920-8642.2026.015

Abstract

Abstract:

BACKGROUND: Sepsis survivors experience poor long-term quality of life post-discharge. The aim of this study was to analyze the factors that impact the long-term quality of life of sepsis survivors and develop a clinical prediction model.

METHODS: A total of 442 sepsis patients from the Emergency Intensive Care Unit of a tertiary hospital in Wenzhou were included. These patients were assigned to the training set or the validation set at a ratio of 7:3. The European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L) questionnaire was used to evaluate the quality of life in sepsis survivors one year after discharge. Multivariate logistic regression analysis was used to identify predictors, which were then used to develop the prediction model and subsequently derive a scoring system. The model's effectiveness was assessed using an area under the receiver operating characteristic curve, calibration curves, and clinical decision analysis.

RESULTS: Of the 442 patients included, 70 died one year after discharge, and 372 completed the questionnaire. A total of 46.6% of sepsis survivors have poor quality of life one year after discharge in the training set. Multivariate logistic regression revealed that age, platelet, serum albumin, serum urea, and C-reactive protein were independent risk factors for poor quality of life in sepsis survivors. The area under the curve of the scoring system was 0.777 (95% CI: 0.726-0.828). The calibration curves showed that it was well calibrated. Decision curve analysis indicated that the scoring system provided good clinical usefulness. The internal validation also demonstrated its effectiveness.

CONCLUSION: The prediction model incorporating five risk factors may predict quality of life one year after discharge in sepsis survivors, which provides a measure to develop post-discharge rehabilitation and follow-up plans for this patient population.

Key words: Sepsis, Sepsis survivors, Quality of life, EQ-5D-5L, Prediction model

Yi Yao, Wenjin Li, Dejiang Hong, Ze Chen, Kai Peng, Guangju Zhao. Prediction model for quality of life in sepsis survivors one year after discharge[J]. World Journal of Emergency Medicine, 2026, 17(2): 105-112.

Figures/Tables 5

Figure 1.

Table 1.

Baseline characteristics of sepsis survivors in the training and validation sets

Variables	Training set (n=309)	Validation set (n=133)	P-value
Age, median (IQRs), years	65.00 (51.00, 74.00)	68.00 (55.00, 76.00)	0.434
Female, n (%)	128 (41.42)	56 (42.11)	0.894
BMI, median (IQRs), kg/m²	22.99 (20.20, 25.85)	22.49 (20.80, 24.49)	0.153
Length of hospital stay, median (IQRs), d	13 (10, 20)	14 (10, 21)	0.615
Length of ICU stay, median (IQRs), d	4 (3, 6)	4 (3, 7)	0.881
Comorbidities, n (%)
Hypertension	160 (51.78)	70 (52.63)	0.869
Diabetes mellitus	119 (38.51)	54 (40.60)	0.680
Chronic kidney disease	50 (16.18)	18 (13.53)	0.479
Cardiac disease	97 (31.39)	35 (26.32)	0.285
Liver disease	46 (14.89)	20 (15.04)	0.967
Treatment, n (%)
Invasive mechanical ventilation	36 (11.65)	11 (8.27)	0.290
Vasoactive drugs	198 (64.08)	89 (66.92)	0.566
Renal replacement therapy	73 (23.62)	38 (28.57)	0.271
Primary site of infection, n (%)
Abdominal	97 (31.39)	41 (30.83)	0.906
Pulmonary	67 (21.68)	25 (18.80)	0.493
Urinary	54 (17.48)	35 (26.32)	0.034
Skin and soft tissue	29 (9.39)	10 (7.52)	0.526
Other	62 (20.06)	22 (16.54)	0.387
Laboratory indicators, median (IQRs)
Lymphocytes count, 10⁹/L	1.32 (0.93, 1.87)	1.40 (0.94, 1.92)	0.233
Platelet count, 10⁹/L	197.00 (114.00, 303.00)	217.00 (114.00, 311.00)	0.602
Bilirubin, μmol/L	14.00 (10.00, 21.00)	13.00 (10.00, 20.00)	0.376
Serum albumin, g/L	31.20 (28.50, 34.50)	32.00 (29.30, 34.90)	0.100
Creatinine, μmol/L	76.00 (58.00, 122.00)	74.00 (58.00, 139.00)	0.861
Urea, mmol/L	7.80 (4.50, 10.70)	7.90 (4.20, 12.50)	0.837
C-reactive protein, mg/L	18.80 (7.50, 49.10)	17.80 (8.90, 46.60)	0.817
D-dimer, mg/L	2.35 (1.46, 4.23)	2.40 (1.35, 4.33)	0.710
Death, n (%)	49 (15.86)	21 (15.79)	0.986
Quality of life, n (%)			0.882
Normal	165 (53.40)	70 (52.63)
Poor	144 (46.60)	63 (47.37)
EQ‐5D‐5L index, median (IQRs)	0.86 (0.51, 1.00)	0.86 (0.51, 1.00)	0.914
EQ-VAS score, median (IQRs)	88.00 (71.00, 99.00)	88.00 (72.00, 97.00)	0.610

Table 1.

Table 2.

Univariate and multivariate logistic regression analysis of risk factors for poor quality of life of sepsis survivors in the training set

Variables	Univariate analysis			Multivariate analysis
Variables	Beta	OR (95%CI)	P-value	Beta	OR (95%CI)	P-value
Age, years	1.310	3.707 (2.306-5.959)	<0.001	0.030	1.030 (1.010-1.051)	0.003
Female, n (%)	0.142	1.153 (0.732-1.816)	0.540
Body mass index, kg/m²	0.005	1.005 (0.981-1.031)	0.670
Length of hospital stay, d	0.020	1.020 (0.999-1.041)	0.057
Length of ICU stay, d	0.025	1.025 (0.979-1.074)	0.292
Comorbidities, n (%)
Hypertension	0.494	1.639 (1.044-2.574)	0.032	0.059	1.061 (0.595-1.892)	0.842
Diabetes mellitus	0.525	1.691 (1.066-2.685)	0.026	0.217	1.242 (0.709-2.178)	0.449
Chronic kidney disease	0.847	2.333 (1.246-4.371)	0.008	0.523	1.687 (0.722-3.944)	0.227
Cardiac disease	0.905	2.471 (1.508-4.048)	<0.001	0.210	1.233 (0.655-2.322)	0.516
Liver disease	-0.045	0.956 (0.510-1.793)	0.889
Treatment, n (%)
Invasive mechanical ventilation	0.936	2.550 (1.225-5.307)	0.012	0.917	2.501 (0.996-6.277)	0.051
Vasoactive drugs	0.098	1.103 (0.692-1.758)	0.681
Renal replacement therapy	0.650	1.916 (1.125-3.264)	0.017	-0.034	0.967 (0.441-2.117)	0.933
Primary site of infection, n (%)
Abdominal	-0.440	0.644 (0.395-1.050)	0.078
Pulmonary	0.520	1.681 (0.974-2.902)	0.062
Urinary	-0.196	0.822 (0.454-1.486)	0.516
Skin and soft tissue	0.693	2.000 (0.911-4.390)	0.084
Other	-0.154	0.857 (0.489-1.502)	0.857
Laboratory indicators
Lymphocytes count, 10⁹/L	-0.166	0.847 (0.627-1.144)	0.280
Platelet count, 10⁹/L	-0.004	0.996 (0.994-0.998)	<0.001	-0.003	0.997 (0.995-0.999)	0.014
Bilirubin, μmol/L	0.007	1.007 (1.000-1.013)	0.048	0.002	1.002 (0.996-1.008)	0.514
Serum albumin, g/L	-0.107	0.898 (0.854-0.945)	<0.001	-0.067	0.935 (0.881-0.993)	0.027
Creatinine, μmol/L	0.004	1.004 (1.002-1.007)	0.001	0.000	1.000 (0.996-1.004)	0.874
Urea, mmol/L	0.050	1.051 (1.031-1.072)	<0.001	0.073	1.076 (1.008-1.149)	0.029
C-reactive protein, mg/L	0.018	1.018 (1.010-1.026)	<0.001	0.011	1.011 (1.003-1.020)	0.007
D-dimer, mg/L	0.142	1.153 (1.071-1.241)	<0.001	0.076	1.079 (0.995-1.170)	0.065

Table 2.

Figure 2.

Figure 3.

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