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

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.