Abstract
Patients with sepsis may have an increased risk of late mortality, but the causes of late death are unclear. This retrospective matched cohort study aimed to determine the causes of late death (≥1year) among patients with sepsis compared to patients without sepsis. 8760 patients with severe sepsis or septic shock (2001 consensus criteria) registered in the Swedish Intensive Care Registry (2008-2013) were compared with a 1:1 matched (gender, age, SAPS3 probability for death, ICU length of stay) control group consisting of non-septic ICU patients. Causes of death (International Classification of Diseases codes) were obtained from the Swedish Cause of Death Register (2008-2014). During 2008-2014, 903 patients with sepsis died at≥365days after their initial septic event, compared to 884 patients in the control group. Median time of follow-up was 313days (sepsis group, interquartile range 11-838days) vs 288days (control group, 9-836days). The most common causes of death were heart diseases (sepsis: 50.2%, non-septic: 48.6%) and cancer (sepsis: 33.7%, non-septic: 31.7%). Infectious diseases were significantly more common cause of death in the sepsis group (24.3% vs 19.6%, respectively; P<.05). Pneumonia was a common infectious cause of death in both groups, whereas sepsis was more common in the sepsis group. The most common causes of late death after ICU admission among patients with and without sepsis were heart diseases and cancer. However, patients with sepsis more frequently had infectious diseases as a cause of late death, compared to non-septic patients.
Highlights
Patients with sepsis may have an increased risk of late mortality, but the causes of late death are unclear
Despite improved awareness in recent years, the acute mortality rates remain high for sepsis (15% based on the Sepsis-3 definition)[3] and septic shock
The present cohort study identified patients in the Swedish Intensive care Registry (SIR) database who were treated in an ICU during 2008-2013 for severe sepsis or septic shock, based on the 2001 consensus criteria.[2]
Summary
Severe sepsis involves an infection that causes the host's immune response to damage its own tissues and organs, which can lead to organ dysfunction and death in some cases.[1,2,3] Despite improved awareness in recent years, the acute mortality rates remain high for sepsis (15% based on the Sepsis-3 definition)[3] and septic shock (50%).[4,5] There is on-going debate regarding whether the sepsis episode itself contributes to long-term mortality, or if late mortality is primarily influenced by comorbidities that existed before the septic event.[6]. Prescott et al attempted to address whether late mortality (31 days to 2 years) after sepsis was driven by pre-existing disease or was the result of sepsis itself.[8] They used matched control groups (non-hospitalized adults, patients admitted with non-septic infections and patients admitted with sterile inflammatory conditions), and found that sepsis was associated with a 22% absolute increase in late mortality relative to non-hospitalized adults. More information about actual causes of late death in patients with previous episodes of sepsis may in the long-run result in better post-ICU care for this group of patients It may generate new hypotheses regarding longstanding physiological or immunological alterations in patients with sepsis. The present study was undertaken to determine the causes of late deaths in sepsis patients treated in the ICU compared to a matched cohort of non-sepsis ICU patients with similar disease severity
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