Late mortality after sepsis: propensity matched cohort study

Hallie C Prescott, John J Osterholzer, Kenneth M Langa, Derek C Angus, Theodore J Iwashyna, Hallie C Prescott, John J Osterholzer, Kenneth M Langa, Derek C Angus, Theodore J Iwashyna

Abstract

Objectives: To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

Deign: Observational cohort study.

Setting: US Health and Retirement Study.

Participants: 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

Main outcome measures: Late (31 days to two years) mortality and odds of death at various intervals.

Results: Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

Conclusions: More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4869794/bin/preh031728.f1_default.jpg
Fig 1 Flow of participants and match of patients with sepsis
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4869794/bin/preh031728.f2_default.jpg
Fig 2 Kaplan-Meier survival curves for sepsis cohort versus three matched comparisons showing long term survival of patients who survived at least 30 days after their match day
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4869794/bin/preh031728.f3_default.jpg
Fig 3 Absolute excess late mortality of sepsis v adults not currently in hospital, stratified by subgroup. GI=gastrointestinal; GU=genitourinary

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