Long-term Quality of Life in Adult Patients Surviving Purpura Fulminans: An Exposed-Unexposed Multicenter Cohort Study
Authors: Contou Damien , Canoui-Poitrine Florence , Coudroy Rémi , Préau Sébastien , Cour Martin , Barbier François , Terzi Nicolas , Schnell Guillaume , Galbois Arnaud , Zafrani Lara , Zuber Benjamin , Ehrmann Stephan , Gelisse Elodie , Colling Delphine , Schmidt Matthieu , Jaber Samir , Conia Alexandre , Sonneville Romain , Colin Gwenhaël , Guérin Laurent , Roux Damien , Jochmans Sébastien , Kentish-Barnes Nancy , Audureau Etienne , Layese Richard , Alves Aline , Ouedraogo Rachida , Brun-Buisson Christian , Mekontso Dessap Armand , de Prost Nicolas ,   Hopeful Study Group, Argaud Laurent , Barbier François , Bazire Amélie , Béduneau Gaëtan , Bellec Frédéric , Beuret Pascal , Blanc Pascal , Bruel Cédric , Brun-Buisson Christian , Colin Gwenhaël , Colling Delphine , Conia Alexandre , Coudroy Rémi , Cour Martin , Contou Damien , Daviaud Fabrice , Das Vincent , Dellamonica Jean , Demars Nadège , Ehrmann Stephan , Galbois Arnaud , Gelisse Elodie , Grouille Julien , Guérin Laurent , Guérot Emmanuel , Jaber Samir , Jannière Caroline , Jochmans Sébastien , Jozwiak Mathieu , Kalfon Pierre , Kimmoun Antoine , Lautrette Alexandre , Layese Richard , Lemarié Jérémie , Le Moal Charlène , Lenclud Christophe , Lerolle Nicolas , Leroy Olivier , Marchalot Antoine , Mégarbane Bruno , Mekontso Dessap Armand , de Montmollin Etienne , Pène Frédéric , Pichereau Claire , Plantefève Gaëtan , Préau Sébastien , Preda Gabriel , de Prost Nicolas , Quenot Jean-Pierre , Ricome Sylvie , Roux Damien , Sauneuf Bertrand , Schmidt Matthieu , Schnell Guillaume , Sonneville Romain , Tadié Jean-Marc , Tandjaoui Yacine , Tchir Martial , Terzi Nicolas , Valette Xavier , Zafrani Lara , Zuber Benjamin 
Published: October 2018

Abstract

Background
Long-term health-related quality of life (HR-QOL) of patients surviving the acute phase of purpura fulminans (PF) has not been evaluated.

Methods
This was a French multicenter exposed-unexposed cohort study enrolling patients admitted in 55 intensive care units (ICUs) for PF from 2010 to 2016. Adult patients surviving the acute phase of PF (exposed group) were matched 1:1 for age, sex, and Simplified Acute Physiology Score II with septic shock survivors (unexposed group). HR-QOL was assessed during a phone interview using the 36-Item Short-Form Health Survey (SF-36) questionnaire, the Hospital Anxiety and Depression (HAD) scale, the Impact of Event Scale–Revised (IES-R), and the activity of daily living (ADL) and instrumental ADL (IADL) scales. The primary outcome measure was the physical component summary (PCS) of the SF-36 questionnaire.

Results
Thirty-seven survivors of PF and 37 of septic shock were phone-interviewed at 55 (interquartile range [IQR], 35–83) months and 44 (IQR, 35–72) months, respectively, of ICU discharge (P = .23). The PCS of the SF-36 was not significantly different between exposed and unexposed patients (median, 47 [IQR, 36–53] vs 54 [IQR, 36–57]; P = .18). There was also no significant difference between groups regarding the mental component summary of the SF-36, and the HAD, IES-R, ADL and IADL scales. Among the 37 exposed patients, those who required limb amputation (n = 12/37 [32%]) exhibited lower PCS (34 [IQR, 24–38] vs 52 [IQR, 42–56]; P = .001) and IADL scores (7 [IQR, 4–8] vs 8 [IQR, 7–8]; P = .021) compared with nonamputated patients.

Conclusions
Long-term HR-QOL does not differ between patients surviving PF and those surviving septic shock unrelated to PF. Amputated patients have an impaired physical HR-QOL but a preserved mental health.

Clinical Trials Registration
NCT03216577.