Occurrence and Risk Factors for New Dependency on Chronic Care, Respiratory Support, Dialysis and Mortality in the First Year After Sepsis

Abstract

Sepsis survival is associated with adverse outcomes. Knowledge about risk factors for adverse outcomes is lacking. We performed a population-based cohort study of 116,507 survivors of hospital-treated sepsis identified in health claims data of a German health insurance provider. We determined the development and risk factors for long-term adverse events: new dependency on chronic care, chronic dialysis, long-term respiratory support, and 12-month mortality. At-risk patients were defined by absence of these conditions prior to sepsis. Risk factors were identified using simple and multivariable logistic regression analyses. In the first year post-sepsis, 48.9% (56,957) of survivors had one or more adverse outcome, including new dependency on chronic care (31.9%), dialysis (2.8%) or respiratory support (1.6%), and death (30.7%). While pre-existing comorbidities adversely affected all studied outcomes (>4 comorbidities: OR 3.2 for chronic care, OR 4.9 for dialysis, OR 2.7 for respiratory support, OR 4.7 for 12-month mortality), increased age increased the odds for chronic care dependency and 12-month mortality, but not for dialysis or respiratory support. Hospital-acquired and multi-resistant infections were associated with increased risk of chronic care dependency, dialysis, and 12-month mortality. Multi-resistant infections also increased the odds of respiratory support. Urinary or respiratory infections or organ dysfunction increased the odds of new dialysis or respiratory support, respectively. Central nervous system infection and organ dysfunction had the highest OR for chronic care dependency among all infections and organ dysfunctions. Our results imply that patient- and infection-related factors have a differential impact on adverse life changing outcomes after sepsis. There is an urgent need for targeted interventions to reduce the risk.

Sepsis in Latvia—Incidence, Outcomes, and Healthcare Utilization: A Retrospective, Observational Study

“…In contrast to the high case fatality rate in Latvian hospitals, the observed 12% one-year mortality rate for sepsis survivors is relatively low. For comparison, studies focusing on one-year mortality rates for patients discharged after an initial sepsis hospitalization report figures such as 12.5% [40], 15% [41], 22.3% [42], 23% [43], and even as high as 30.7% [37,44]. Furthermore, a meta-analysis indicates a post-acute sepsis mortality rate of 16.1% at one year, derived by estimating the difference between cumulative one-year mortality and acute mortality across 43 studies that did not specifically focus on this outcome [45].…”

Prevalence and Long-Term Prognosis of Post-Intensive Care Syndrome after Sepsis: A Single-Center Prospective Observational Study

“…Patients with sepsis often have compromised host immune responses that are characterized by lymphopenia [48,49]; in 25% of sepsis patients who were readmitted with sepsis, the same pathogen was isolated, and a previous gram-negative bacteremia and/or samesite infection predisposed to recurrence of sepsis that was caused by the same pathogen [29]. In addition, nosocomial and multidrug-resistant infections increase the odds of respiratory support and are associated with an increased 12-month mortality risk [50]. Furthermore, our study demonstrated that survivors who had PICS 3 months after sepsis showed a lower number of lymphocytes, and a higher detection rate of MRSA-and ESBL-producing bacteria and fungi in blood cultures.…”

Challenges of assessing the burden of sepsis

“…For example, 31.5% of survivors with no prior need for care had new care needs [ 16 ]. In particular, pre-existing comorbidities increased the risk for adverse outcomes after sepsis [ 17 ]. Long-term mortality in the first 12 months after discharge was 30.7% [ 16 ].…”