Association of postdischarge rehabilitation with mortality in intensive care unit survivors of sepsis

Am J Respir Crit Care Med. 2014 Nov 1;190(9):1003-11. doi: 10.1164/rccm.201406-1170OC.


Rationale: Intensive care unit (ICU)-acquired weakness is a common issue for sepsis survivors that is characterized by impaired muscle strength and causes functional disability. Although inpatient rehabilitation has not been found to reduce in-hospital mortality, the impact of postdischarge rehabilitation on sepsis survivors is uncertain.

Objectives: To investigate the benefit of postdischarge rehabilitation to long-term mortality in sepsis survivors.

Methods: We conducted a nationwide, population-based, high-dimensional propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. The rehabilitation cohort comprised 15,535 ICU patients who survived sepsis and received rehabilitation within 3 months after discharge between 2000 and 2010. The control cohort consisted of 15,535 high-dimensional propensity score-matched subjects who did not receive rehabilitation within 3 months after discharge. The endpoint was mortality during the 10-year follow-up period.

Measurements and main results: Compared with the control cohort, the rehabilitation cohort had a significantly lower risk of 10-year mortality (adjusted hazard ratio, 0.94; 95% confidence interval, 0.92-0.97; P < 0.001), with an absolute risk reduction of 1.4 per 100 person-years. The frequency of rehabilitation was inversely associated with 10-year mortality (≥3 vs. 1 course: adjusted hazard ratio, 0.82; P < 0.001). Compared with the control cohort, improved survival was observed in the rehabilitation cohort among ill patients who had more comorbidities, required more prolonged mechanical ventilation, and had longer ICU or hospital stays, but not among those with the opposite conditions (i.e., less ill patients).

Conclusions: Postdischarge rehabilitation may be associated with a reduced risk of 10-year mortality in the subset of patients with particularly long ICU courses.

Keywords: epidemiology; mortality; rehabilitation; sepsis.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Cohort Studies
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Muscle Weakness / etiology
  • Muscle Weakness / rehabilitation*
  • Patient Discharge
  • Propensity Score
  • Risk Assessment
  • Sepsis / complications
  • Sepsis / mortality*
  • Survivors