Postdischarge Survival After Sepsis: A Cohort Study.

Area of Science:

• Critical Care Medicine
• Epidemiology
• Health Services Research

Background:

• Sepsis survivors experience elevated mortality rates after hospital discharge.
• Understanding factors influencing post-discharge mortality and their temporal changes is crucial for patient outcomes.

Purpose of the Study:

• To estimate factors associated with post-discharge mortality in sepsis survivors.
• To analyze how these associations change over time after hospital discharge.

Main Methods:

• Retrospective study of hospital survivors of sepsis.
• Utilized time-varying Cox proportional hazard models to assess mortality risk.
• Analyzed hazard ratios (HR) and time-dependent hazard ratios (δHR) to capture temporal effects.

Main Results:

• 42% of 32,244 sepsis survivors died post-discharge; mortality rate decreased over time.
• Organ dysfunction at discharge (e.g., elevated urea nitrogen) was linked to worse survival, with decreasing association over time.
• Older age, Medicaid, and Medicare insurance were associated with increased mortality, with varying temporal trends.

Conclusions:

• Acute physiologic derangements and organ dysfunction are key predictors of post-discharge mortality.
• The impact of these factors on mortality diminishes over time.
• Long-term monitoring and risk stratification are essential for sepsis survivors.