Hospital Free Days and Symptom Burden After Sepsis
Bibliographic record
Abstract
Abstract Rationale: Hospital-free days (HFD, i.e., days spent outside any hospital setting) is a patient-centered outcome used to capture post-discharge morbidity in seriously ill patients, but its relationship with other patient-reported outcomes in sepsis survivors is unknown. We assessed the relationship between HFD and health-related quality of life (HRQoL), cognition, post-traumatic stress, and dyspnea 90 days post-discharge in patients with sepsis from pneumonia. Methods: Prospective cohort study of patients admitted with sepsis and pneumonia and enrolled in a sepsis transition recovery trial August 2021-December 2022 at eight hospitals (NCT04495946). Participants completed telephone surveys at 90 days post-discharge. Surveys included the EuroQol Five Dimension (EQ-5D) questionnaire, Montreal Cognitive Assessment (MOCA), Impact of Events Scale (IES-6), and modified Medical Research Council Dyspnea Scale (mMRC). HFD were extracted from electronic medical records. Participants were categorized into three groups using median (HFD=90) and first quartile (HFD=86) of the HFD distribution. We compared HRQoL and symptom scores between HFD-derived patient groups using analysis of variance and Kruskal-Wallis tests. Results: 24 survey respondents were analyzed. 90 days post-discharge, 9 patients had experienced 90 HFD (Group A), 8 patients had 87-89 HFD (Group B), and 7 patients had ≤86 HFD days (Group C). Group A was older (median age=71 years, 40 to 78 [versus Group B: 63, 57 to 71; Group C: 60, 51 to 87]), had fewer comorbidities (median Charlson Comorbidity Index=3, 1 to 4 [versus Group B: 4, 2 to 8; Group C: 6, 4 to 7]), and had the lowest SOFA score at trial enrollment (median=3, 2 to 7 [versus Group B: 4, 2 to 4; Group C: 4, 2 to 7]). Nearly all participants in Group B (7/8: 87.5%) had coexisting COPD. Group A reported the highest health utility index score compared to Groups B and C (p=0.01). Group B reported the greatest burden of dyspnea and worst HRQoL (including moderate to severe problems on mobility, usual activities, and pain or discomfort EQ-5D domains, see Table). No significant differences were found in mini-MOCA or IES-6 scores between groups. Conclusions: In this small survey study of hospital sepsis survivors, we observed variation in HRQoL at 90 days. However, we did not find clear associations between HFD and patient-reported HRQoL or other metrics like post-traumatic stress, cognition, and dyspnea. Future studies are needed to assess the impact of comorbidities, index hospital factors, and patient patterns for seeking healthcare on HFD and its association with HRQoL.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".