Long-Term Mortality in Sepsis Survivors: A Population-Based Study During 15 Years
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Carolina Lorencio-Cárdenas1,2, Emili Vela3, Elisabeth Esteban-Torné4
1Intensive Care Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain.
Objectives:
To evaluate long-term mortality among sepsis survivors in Catalonia over a 15-year period and to identify factors associated with increased mortality within 2 years after hospital discharge.
Design:
Retrospective population-based cohort study.
Setting:
Acute-care hospitals in Catalonia, Spain.
Patients:
Adult and pediatric patients hospitalized with sepsis between 2005 and 2019 identified using the International Classification of Diseases, 9th Revision, Clinical Modification and International Classification of Diseases, 10th Revision, Clinical Modification codes for infection and acute organ dysfunction. Patients who died during hospitalization, were transferred to another facility, or represented readmission episodes were excluded.
Interventions:
None.
Measurements And Main Results:
Data were obtained from the Catalan Minimum Basic Dataset of Acute-Care Hospitals, with longitudinal follow-up through the Central Registry of Insured Persons. Comorbidities were assessed using the Charlson comorbidity index. Logistic regression and Cox proportional hazards models were used to identify predictors of long-term mortality. Among 296,554 hospital admissions for sepsis, 237,075 patients (79.9%) survived to hospital discharge. Of these, 42% died (99,571) within 2 years. Long-term mortality increased significantly with age, ranging from 5.8% in patients younger than 15 years to 62% in those older than 84 years (p < 0.0001), and with comorbidity burden (21%, 38%, 51%, and 67% for Charlson index 0, 1-2, 3-4, and ≥ 5, respectively; p < 0.0001). Neoplasia (hazard ratio [HR], 2.011), liver cirrhosis (HR, 1.562), and dementia (HR, 1.304) were the comorbidities most strongly associated with mortality. Longer hospital stays were also associated with increased mortality. A progressive decline in long-term mortality was observed during 2017-2019.
Conclusions:
Long-term mortality among sepsis survivors remains high, with more than 40% dying within 2 years after hospital discharge. These findings support the need for structured post-sepsis care strategies focused on high-risk patients, improved continuity of care, and prevention of long-term sepsis-related complications.
