Health-related quality of life among patients with sepsis in Blantyre, Malawi: an observational cohort study

Abstract Sepsis is a life-threatening condition with high mortality, especially in sub-Saharan Africa (SSA). Sepsis survivors may face long term consequences and experience poor health-related quality of life (HRQoL). By comparing HRQoL trajectories between sepsis cases and matched controls we sought to identify the longitudinal impact of sepsis on HRQoL in the SSA context. This study was nested within a longitudinal adult sepsis cohort admitted to hospital in Blantyre, Malawi. Two reference control groups matched to cases by age, sex, and geographical location were recruited: (1) hospital inpatients without sepsis and (2) community controls with no current illness. All participants were followed up to 180 days post-enrolment. HRQoL was assessed using EQ-5D-3L questionnaire and a visual analogue scale (VAS). Regression analysis was conducted to examine factors associated with HRQoL among sepsis survivors. A total of 425 participants: 225 sepsis cases, 100 hospital controls, and 100 community controls were recruited. HIV prevalence was higher among sepsis cases 143/225 (63.6%) compared to hospital controls 12/100 (12.0%) and community controls 18/100 (18.0%) p= <0.001. At baseline, sepsis cases had lower health utility scores (median 0.596, IQR: 0.365– 0.734 compared to hospital controls (0.666, IQR: 0.611 - 0.722) and community controls (0.900, IQR: 0.833 - 0.900). Over time, sepsis cases displayed fluctuating HRQoL, with a marked decline in utility scores at day 180 (0 IQR: 0 - 0) compared to relatively stable scores in both control groups. Regression analysis identified age, sex, duration of illness before admission and baseline utility score as significant predictors of HRQoL in the sepsis group. The findings reveal a severe and persistent reduction in HRQoL among patients admitted with sepsis in Malawi, suggesting a substantial post-discharge burden among survivors. These results point to a need for evidence-based prevention, early recognition of sepsis and post-sepsis support programs in SSA. Competing Interest Statement The authors have declared no competing interest. Funding Statement This research was funded by the NIHR (NIHR201708) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK government. Authors who received the award include E.W, B.M and M.P.R. This work was also funded by a Wellcome Clinical PhD fellowship to J.M.L. (109105z/15/a) and J.M.L. was also supported by an NIHR clinical lectureship (CL-2019-07-001). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The cohort study was approved by the University of Malawi College of Medicine research ethics committee (approval number P.11/16/2063) and the Liverpool School of Tropical Medicine (approval number 16-062). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data underlying the findings of this study are fully available without restriction. The datasets have been deposited in publicly accessible repositories and can be accessed via the following links: https://github.com/joelewis101/blantyreESBL https://github.com/joelewis101/blantyreSepsis