Post-Sepsis Syndrome: Long-Term Harm and Damages in Oregon

For some patients, surviving sepsis is not the end of the injury. The Centers for Disease Control and Prevention describes sepsis as "the body's extreme response to an infection" and states that "It is a life-threatening medical emergency."¹ When a patient lives through it, the effects can continue long after discharge from the hospital.

This article looks at those lasting effects and at how Oregon's damages statute sorts the losses they produce. It does not address whether any provider was negligent. Other articles on this site cover that question, including how Oregon law views a missed sepsis diagnosis and the sepsis one-hour bundle and the standard of care.

What "post-sepsis syndrome" describes

A 2019 review in Molecular Medicine stated: "Post-sepsis syndrome is an emerging pathological entity that has garnered significant interest amongst clinicians and researchers over the last two decades."² The review continued: "It is marked by a significantly increased risk of death and a poor health-related quality of life associated with a constellation of long-term effects that persist following the patient's bout with sepsis. These include neurocognitive impairment, functional disability, psychological deficits, and worsening medical conditions."²

The 2021 Surviving Sepsis Campaign guidelines also describe lasting effects: "Many sepsis survivors experience short and/or long-term sequela such as cognitive and/or physical disability, with ongoing recovery persisting for months to years."³

Lasting harm is not the only outcome. The CDC states: "Many people who survive sepsis recover completely and their lives return to normal."⁴ It also states: "Generally, the effects of sepsis improve with time."⁴ Which of these paths a particular patient is on is a medical question.

The recognised long-term effects

The CDC explains that, as with some other illnesses requiring intensive medical care, some patients have long-term effects after sepsis.⁴ It lists effects that can include a risk of amputation, decreased mental (cognitive) functioning, difficulty getting to or staying asleep, disabling muscle and joint pains, kidney failure and respiratory problems, loss of self-esteem and self-belief, and nightmares or panic attacks.⁴ The CDC adds that some of these may not become apparent until after the hospital stay.⁴

The National Institute of General Medical Sciences, part of the National Institutes of Health, states that "Sepsis can also result in lung injury, muscle wasting, cognitive dysfunction, and impaired blood production."⁵

The risk of further illness is part of the picture. The CDC states that "Sepsis survivors are at higher risk for getting sepsis again."⁴ The Surviving Sepsis Campaign guidelines add that sepsis survivors are at increased risk for recurrent infection, acute kidney injury and new cardiovascular events compared to patients hospitalised for other diagnoses.³

Some of these effects are covered in more depth elsewhere on this site, including multiple organ failure after missed sepsis and amputation after delayed sepsis care.

Cognitive and psychological effects

The guidelines state: "Sepsis is associated with newly acquired cognitive impairment and functional disability amongst survivors."³ The 2019 review, discussing cognitive effects in sepsis survivors, stated: "Problems with memory, learning, concentrating, and decision-making affect the daily lives of patients, their caregivers, and their families."²

On emotional health, the review stated: "There are few studies that specifically examine psychiatric issues after sepsis and further investigation is necessary in this area of post-sepsis syndrome research."² It turned instead to research on the neuropsychiatric consequences of surviving critical illness, observing that "Sepsis accounts for a large segment of intensive care unit survivors …"² Discussing patients who have survived critical illness, it stated: "These negative emotional outcomes include anxiety, depression, and post-traumatic stress disorder."² Among the feelings the CDC says a survivor might experience at home are "Poor concentration" and "Frustration at not being able to do everyday tasks".⁴

What the guidelines say about care after discharge

The Surviving Sepsis Campaign guidelines include recommendations aimed at the period after the hospital stay. The panel stated: "For adults with sepsis or septic shock who developed new impairments, we recommend hospital discharge plans include follow-up with clinicians able to support and manage new and long-term sequelae".³ It also stated: "For adult survivors of sepsis or septic shock, we recommend assessment and follow-up for physical, cognitive, and emotional problems after hospital discharge".³

For a narrower group, the guidelines go further: "For adult survivors of sepsis or septic shock receiving mechanical ventilation for > 48 h or an ICU stay of > 72 h, we suggest referral to a post-hospital rehabilitation programme".³ The panel graded that suggestion a "Weak recommendation, very low-quality evidence".³

Work and earning capacity

Lasting impairment can also reach a survivor's working life. A 2023 Norwegian registry study of working-age sepsis patients began from the observation that "Sepsis survivors commonly experience functional impairment, which may limit return to work."⁶ The study uses RTW to mean return to work, and it reported: "Characteristics associated with sustainable RTW were younger age, fewer comorbidities, and fewer acute organ dysfunctions."⁶ A 2023 German study of health-insurance claims data likewise stated that "Long-term impairments after sepsis can impede the return to work in survivors."⁷

These are population studies. They describe groups of patients, not what will happen to any one person.

How Oregon's damages statute sorts these losses

ORS 31.705(1) provides: "A verdict shall set forth separately economic damages and noneconomic damages."⁸ Subsection (2) then defines both terms "As used in this section".⁸ Those definitions are the statute's own description of what falls on each side of that line.

Economic damages. Under ORS 31.705(2)(a), "Economic damages" means "objectively verifiable monetary losses including but not limited to reasonable charges necessarily incurred for medical, hospital, nursing and rehabilitative services and other health care services, burial and memorial expenses, loss of income and past and future impairment of earning capacity, reasonable and necessary expenses incurred for substitute domestic services, …"⁸ The definition continues with further items.⁸

Several of those items line up with the effects described above. The follow-up care, rehabilitation and treatment of new conditions that the guidelines address are the kinds of services named in "medical, hospital, nursing and rehabilitative services and other health care services". The return-to-work research bears on "loss of income and past and future impairment of earning capacity". The definition's opening words matter too: the losses it covers are "objectively verifiable monetary losses".⁸

Noneconomic damages. Under ORS 31.705(2)(b), "Noneconomic damages" means "subjective, nonmonetary losses, including but not limited to pain, mental suffering, emotional distress, humiliation, injury to reputation, loss of care, comfort, companionship and society, loss of consortium, inconvenience and interference with normal and usual activities apart from gainful employment."⁸

Those terms describe the same kinds of loss as several effects in the medical sources above, such as disabling muscle and joint pains, anxiety, nightmares or panic attacks, and frustration at not being able to do everyday tasks. It is the economic definition that names "loss of income and past and future impairment of earning capacity".⁸

Related reading

An earlier article on this site explains how Oregon law treats a surviving patient differently from a deceased one in the context of delayed cancer diagnosis. Time limits for these claims are explained in the article on Oregon's medical-malpractice statute of limitations.

This article is educational

This article describes Oregon law in general terms. It is not legal advice and does not create an attorney-client relationship.

Time limits matter. Most Oregon personal-injury and auto-accident claims must be filed within two years of the injury or accident. Medical malpractice claims must be filed within two years of when you knew or reasonably should have known of the negligence, with an outer limit of five years from the act itself (with a fraud exception). Wrongful death claims must be filed within three years of the date of death. Claims against public bodies (cities, counties, state agencies, public hospitals) require a notice of claim within 180 days. Missing these deadlines typically ends a case.

If you think you may have a claim, call Huegli Law at 971-317-6436 for a free case review. Todd Huegli is licensed in Oregon and consults on cases in Oregon only.

Footnotes

1. About Sepsis. Centers for Disease Control and Prevention. https://www.cdc.gov/sepsis/about/index.html ↩

2. Mostel Z, Perl A, Marck M, et al. Post-sepsis syndrome – an evolving entity that afflicts survivors of sepsis. Molecular Medicine. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6938630/ ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

3. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Medicine. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8486643/ ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

4. Managing Recovery from Sepsis. Centers for Disease Control and Prevention. https://www.cdc.gov/sepsis/living-with/index.html ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

5. Sepsis. National Institute of General Medical Sciences. https://www.nigms.nih.gov/education/fact-sheets/Pages/sepsis.aspx ↩

6. Skei NV, Moe K, Nilsen TIL, et al. Return to work after hospitalization for sepsis: a nationwide, registry-based cohort study. Critical Care. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10652599/ ↩ ↩²

7. Fleischmann-Struzek C, Ditscheid B, Rose N, et al. Return to work after sepsis—a German population-based health claims study. Frontiers in Medicine. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10248449/ ↩

8. ORS 31.705 — Economic and noneconomic damages separately set forth in verdict; "economic damages" and "noneconomic damages" defined. Oregon State Legislature. https://www.oregonlegislature.gov/bills_laws/ors/ors031.html ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷