Risk factors for sepsis: a systematic review and meta-analysis

This study aims to identify key risk factors for the incidence of sepsis through a systematic review and meta-analysis, thereby providing evidence-based medical evidence for its primary prevention and early identification.

Systematic searches were conducted across eight Chinese and English databases (CNKI, Wanfang, SinoMed, VIP, PubMed, Web of Science, Embase, Cochrane Library) from their inception to January 2025. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Meta-analysis was then carried out using RevMan software. Effect sizes were pooled using either fixed- or random-effects models based on heterogeneity, and sensitivity analyses were performed for outcomes with high heterogeneity.

A total of 12,536 records were identified, and 23 studies met the eligibility criteria, of which 21 studies were included in the quantitative meta-analysis. The pooled analyses identified 19 significant factors associated with sepsis incidence, including 18 risk factors and 1 protective factor. The risk factors identified were: age (≥60 years and per-year increase), male sex, low BMI (≤18.5), Black race, diabetes, chronic obstructive pulmonary disease (COPD), cancer, kidney disease, postoperative infection, ASA score >2, GCS score <8, ISS (per-point increase), loss of functional independence, steroid use, mechanical ventilation, history of hospitalization, history of emergency surgery, and previous history of sepsis. Antibiotic use was identified as a significant protective factor. Sensitivity analyses revealed that heterogeneity significantly decreased after excluding specific studies for age, diabetes, postoperative infection, and mechanical ventilation.

This study provides a comprehensive review of risk factors for the incidence of sepsis. Correct identification of these risk factors and early implementation of interventions should be prioritized to reduce the incidence of sepsis.