Long-term mortality after community-acquired sepsis: a longitudinal population-based cohort study

Henry E Wang, Jeff M Szychowski, Russell Griffin, Monika M Safford, Nathan I Shapiro, George Howard, Henry E Wang, Jeff M Szychowski, Russell Griffin, Monika M Safford, Nathan I Shapiro, George Howard

Abstract

Objective: Prior studies have concentrated on the acute short-term outcomes of sepsis, with little focus on its long-term consequences. The objective of this study was to characterise long-term mortality following a sepsis event.

Design: Population-based data from the 30 239 community-dwelling individuals in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.

Setting usa participants: Community-dwelling adults ≥45 years of age. Sepsis was defined as hospitalisation or emergency department treatment for a serious infection with the presence of ≥2 systemic inflammatory response syndrome criteria.

Outcomes: 6-year all-cause mortality. The analysis utilised a time-varying Cox model adjusted for participant's age, demographic factors, health behaviours and chronic medical conditions.

Results: The participants were observed for a median of 6.1 years (IQR 4.5-7.1). During this period, 975 individuals experienced a sepsis event. Sepsis hospital mortality was 8.9%. One-year, 2-year and 5-year all-cause mortality among individuals with sepsis were 23%, 28.8% and 43.8%, respectively, compared with death rates of 1%, 2.6% and 8.3% among those who never developed sepsis. On multivariable analysis, the association of sepsis with increased all-cause mortality persisted for up to 5 years, after adjustment for confounders; year 0.00-1.00, adjusted HR (aHR) 13.07 (95% CI 10.63 to 16.06); year 1.01-2.00 aHR 2.64 (1.85 to 3.77); year 2.01-3.00 aHR 2.18 (1.43 to 3.33); year 3.01-4.00 aHR 1.97 (1.19 to 3.25); year 4.01-5.00 aHR 2.08 (1.14 to 3.79); year 5.01+ aHR 1.41 (0.67 to 2.98).

Conclusions: Individuals with sepsis exhibited increased rates of death for up to 5 years after the illness event, even after accounting for comorbidities. Sepsis is independently associated with increased risk of mortality well after hospital treatment.

Keywords: Epidemiology; Infectious Diseases.

Figures

Figure 1
Figure 1
Kaplan-Meier curves and 95% CIs for long-term survival after sepsis. Sepsis versus non-sepsis. Includes 970 sepsis and 28 694 non-sepsis individuals. Analysis censored at 6 years.
Figure 2
Figure 2
Adjusted HRs for association of sepsis with long-term survival. Time-dependent effects described using a Cox regression model with all sepsis defined as a time-varying covariate. Analysis censored at 6 years. Each bar reflects the HR for death among individuals alive at the beginning of that time segment. Graph depicts observation time ≥6 months only. Adjusted for age, sex, race, region, health status, smoking, alcohol use, obesity and chronic medical conditions, as reported at the beginning of the REasons for Geographic And Racial Differences in Stroke REGARDS study.

References

    1. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303–10
    1. Wang HE, Shapiro NI, Angus DC, et al. National estimates of severe sepsis in United States emergency departments. Crit Care Med 2007;35:1928–36
    1. Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546–54
    1. Winters BD, Eberlein M, Leung J, et al. Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med 2010;38:1276–83
    1. Brun-Buisson C, Doyon F, Carlet J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 1995;274:968–74
    1. Sasse KC, Nauenberg E, Long A, et al. Long-term survival after intensive care unit admission with sepsis. Crit Care Med 1995;23:1040–7
    1. Perl TM, Dvorak L, Hwang T, et al. Long-term survival and function after suspected gram-negative sepsis. JAMA 1995;274:338–45
    1. Leibovici L, Samra Z, Konigsberger H, et al. Long-term survival following bacteremia or fungemia. JAMA 1995;274:807–12
    1. Howard VJ, Cushman M, Pulley L, et al. The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiology 2005;25:135–43
    1. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 2003;29:530–8
    1. National Institute on Alcohol Abuse and Alcoholism. Helping Patients Who Drink Too Much, a Clinician's Guide NIH publication 2015:07-3769, available at .
    1. Gotch FA, Kotanko P, Thijssen S, et al. The KDIGO guideline for dialysate calcium will result in an increased incidence of calcium accumulation in hemodialysis patients. Kidney Int 2010;78:343–50
    1. Janssen I, Katzmarzyk PT, Ross R. Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Intern Med 2002;162:2074–9
    1. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–10
    1. Royston P, Lambert PC. Flexible parametric survival analysis using Stata: beyond the Cox model. College Station, TX: Stata Press, 2011
    1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580–637
    1. Iwashyna TJ, Odden A, Rohde J, et al. Identifying patients with severe sepsis using administrative claims: patient-level validation of the Angus Implementation of the International Consensus Conference Definition of Severe Sepsis. Medical Care Epub ahead of print: 18 Sept 2012
    1. Yende S, Angus DC, Ali IS, et al. Influence of comorbid conditions on long-term mortality after pneumonia in older people. J Am Geriatr Soc 2007;55:518–25
    1. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813–18
    1. Walkey AJ, Wiener RS, Ghobrial JM, et al. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA 2011;306:2248–54
    1. Iwashyna TJ, Ely EW, Smith DM, et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010;304:1787–94
    1. Karlsson S, Ruokonen E, Varpula T, et al. Long-term outcome and quality-adjusted life years after severe sepsis. Crit Care Med 2009;37:1268–74

Source: PubMed

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