Phenotypes of Functional Decline or Recovery in Sepsis ICU Survivors: Insights From a 1-Year Follow-Up Multicenter Cohort Analysis.

Summary

In 220 sepsis ICU survivors across 21 ICUs, four PICS phenotypes were identified at discharge with distinct 12-month trajectories. Mild PICS improved by 3 months, whereas moderate/severe PICS disabilities persisted and were associated with reduced QoL, low employment, and declining survival in the most severe group.

Key Findings

• Four PICS phenotypes at discharge: none (n=62), mild physical/cognitive (n=55), moderate all domains (n=53), severe all domains (n=50)
• Mild PICS improved by 3 months; moderate/severe PICS disabilities persisted over 12 months
• All groups had persistently reduced QoL and low employment (0–50%); group 4 showed continuous survival decline

Clinical Implications

Use discharge assessments (Barthel Index, cognitive and psychiatric scales, EQ-5D) to phenotype PICS and prioritize intensive rehabilitation for moderate/severe groups with persistent deficits.

Limitations

• Observational design limits causal inference
• Generalizability may be limited to similar ICU settings and healthcare systems

Future Directions

Test phenotype-guided rehabilitation and mental health interventions, and integrate phenotype-based stratification into post-sepsis clinical trials.