Long-term consequences of severe infections.

There are convincing data to show that the consequences of a severe infection extend well beyond the first month following it. During the first year after severe sepsis or infection, the survival of sepsis patients is guarded compared with matched control groups. Their quality of life is impaired, and they suffer from rapid degradation in cognition and functional capacity. We could postulate three explanations for the long-term bad outcomes of severe infections and sepsis (or a combination of the three): (i) sepsis usually happens in the elderly and sick, and it causes deterioration in life expectancy and functional status as an acute, non-specific event; (ii) an interaction between specific mechanisms of sepsis and underlying disorders; or (iii) long-term complications directly related to infection. If the second or third explanations are true, then management of the original infection/sepsis might have an influence on long-term outcomes. Elderly survivors of severe infections should be carefully assessed for whether they need intermediate care for recuperation and re-conditioning when leaving hospital. We need prospective, observational studies to define which are the factors that most influence long-term outcomes, and especially management of the acute infection. The investigation of long-term outcomes in trials of treatment modalities for sepsis or severe infections should be encouraged. The true answer for whether one treatment is better than another in severe infections or sepsis lies in the people trajectory in the year following the infection, and not only on 4-6 weeks outcome.