Understanding Long-Term Outcomes Following Sepsis: Implications and Challenges

Manu Shankar-Hari, Gordon D Rubenfeld, Manu Shankar-Hari, Gordon D Rubenfeld

Abstract

Sepsis is life-threating organ dysfunction due to infection. Incidence of sepsis is increasing and the short-term mortality is improving, generating more sepsis survivors. These sepsis survivors suffer from additional morbidities such as higher risk of readmissions, cardiovascular disease, cognitive impairment and of death, for years following index sepsis episode. In the first year following index sepsis episode, approximately 60 % of sepsis survivors have at least one rehospitalisation episode, which is most often due to infection and one in six sepsis survivors die. Sepsis survivors also have a higher risk of cognitive impairment and cardiovascular disease contributing to the reduced life expectancy seen in this population, when assessed with life table comparisons. For optimal design of interventional trials to reduce these bad outcomes in sepsis survivors, in-depth understanding of major risk factors for these morbid events, their modifiability and a causal relationship to the pathobiology of sepsis is essential. This review highlights the recent advances, clinical and methodological challenges in our understanding of these morbid events in sepsis survivors.

Keywords: Causality; Epidemiology; Long-term outcomes; Morbidity; Mortality; Sepsis; Survivors.

Conflict of interest statement

Drs Shankar-Hari & Rubenfeld have no conflict of interests to declare. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by the author.

Figures

Fig. 1
Fig. 1
Conceptual framework for multiple interacting factors influencing sepsis associated long-term outcomes. The red triangle highlights the vicious cycle between pre-illness morbidity—sepsis—long-term outcomes pathway. The arrows represent direction of relationship between factors. Sepsis occurs in healthy and in subjects with co-morbidities, acutely altering pre-event health state. Thus, complex interactions between pre-sepsis health state and additional morbidity and frailty related to sepsis illness influence post-sepsis health state in sepsis-survivors

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