Impact of event scale-revised-defined early psychological stress and 90-day outcomes in septic shock survivors

BACKGROUNDSeptic shock is associated with high mortality and substantial long-term morbidity.Survivors may experience early trauma-related stress symptoms, anxiety, and depression during recovery.In this study, psychological stress was operationalized as screening positivity on the Impact of Event Scale-Revised (IES-R), not as a formal diagnosis of acute stress disorder or post-traumatic stress disorder.We evaluated the prevalence of IES-Rdefined early psychological stress, its associations with illness severity and 90-day outcomes, and an exploratory multivariable association model in septic shock survivors. AIMTo assess the prevalence of IES-R-defined early psychological stress among septic shock survivors, examine its associations with disease severity and 90-day outcomes, and explore a multivariable model of factors associated with high-stress status. METHODSWe performed a single-center retrospective cohort study of 195 septic shock survivors from 262 screened patients admitted through the Emergency Department between January 2021 and June 2025.The analytic index assessment was performed at intensive care unit (ICU) discharge when discharge occurred before day 7, or on ICU day 7 for patients who remained in the ICU, provided the Richmond Agitation-Sedation Scale score was 0 to +1 and the Confusion Assessment Method for the Intensive Care Unit was negative.The IES-R, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-9 (PHQ-9) were used to assess trauma-related stress, anxiety, and depressive symptoms.High stress was defined operationally as IES-R ≥ 33 (n = 78); 117 patients had IES-R < 33.The multivariable analysis used variables recorded across the ICU course and is therefore presented as an exploratory retrospective association/classification model rather than a 4 / 35 temporally prospective prediction model.Apparent discrimination was summarized by area under the curve (AUC); no bootstrap or external validation was available. RESULTSAmong 195 analyzed patients, 78 (40.0%) met the operational IES-R threshold for high stress.Unadjusted 90-day comparisons showed higher all-cause mortality (24.4% vs 11.1%, P = 0.013), persistent organ dysfunction (32.1% vs 15.4%, P = 0.005), and ICU readmission (19.2% vs 8.5%, P = 0.024) in the high-stress group.The retrospective multivariable model identified seven factors associated with high-stress status: Prior psychiatric history not meeting the active-treatment exclusion criterion [odds ratio (OR) = 3.62, 95% confidence interval (CI): 1.98-6.62],peak Sequential Organ Failure Assessment score ≥ 12 (OR = 3.28, 95%CI: 1.85-5.81),ICU stay > 7 days (OR = 2.75, 95%CI: 1.55-4.88),cortisol > 800 nmol/L (OR = 2.48, 95%CI: 1.42-4.33),female sex (OR = 2.22, 95%CI: 1.32-3.74),mechanical ventilation > 72 hours (OR = 2.08, 95%CI: 1.20-3.60),and absence of family visitation (OR = 1.92, 95%CI: 1.10-3.35).The model showed an apparent AUC of 0.88 (95%CI: 0.83-0.93) in the same derivation cohort. CONCLUSIONIES-R-defined early psychological stress was common in this selected single-center survivor cohort and was associated with greater illness severity and worse unadjusted 90-day outcomes.The seven-variable model showed high apparent discrimination in the derivation cohort but is vulnerable to temporal leakage and overfitting and has not undergone internal resampling or external validation.These findings should be considered exploratory and hypothesis-generating.