In Reply: Our study demonstrated adverse long-term outcomes after severe sepsis. With a substantial body of preceding research,1- 3 we hope that this establishes the importance of identifying the mechanisms of long-term cognitive and physical outcomes of sepsis. We agree with Drs Khandaker and Jones that inflammation and brain interactions, neurotransmitter derangements, and prolonged systemic inflammation may be promising lines of mechanistic inquiry.4,5 A full investigation of these mechanisms is needed that uses not just short-term surrogate end points but true long-term follow-up.
Iwashyna TJ, Ely EW, Langa KM. Cognitive and Functional Impairment After Severe Sepsis—Reply. JAMA. 2011;305(7):673-674. doi:10.1001/jama.2011.143