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Predictors of long-term mortality after severe sepsis in the elderly
Allyson C Lemay1, Antonio Anzueto, Marcos I Restrepo
1VERDICT research program, and South Texas Veterans Health Care System, Audie L. Murphy Division (MIR, EMM), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Divisions of Hospital Medicine (ACL, EMM) and Pulmonary/Critical Care Medicine (MIR, AA), Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Background:
Mortality rates after severe sepsis are extremely high, and the main focus of most research is short-term mortality, which may not be associated with long-term outcomes. The purpose of this study was to examine long-term mortality after a severe sepsis and identify factors associated with this mortality.
Methods:
The authors performed a population-based study using Veterans' Affairs administrative data of patients aged 65 years and older. The outcome of interest was mortality > 90 days following hospitalization. Our primary analyses were Cox proportional hazard models to examine specific risk factors for long-term mortality.
Results:
There were 2,727 patients that met the inclusion criteria. Overall mortality was 55%, and 1- and 2-year mortality rates were 31% and 43%, respectively. Factors significantly associated with long-term mortality included congestive heart failure, peripheral vascular disease, dementia, diabetes with complications and use of mechanical ventilation. Smoking cessation and cardiac medications were associated with decreased long-term mortality rates.
Conclusions:
The authors identified several factors, including receipt of mechanical ventilation, which were significantly associated with increased long-term mortality for survivors of severe sepsis. This information will help clinicians discuss prognosis with patients and their families.
