Long-term Mortality and Hospital Readmissions Among Survivors of Sepsis in Sweden : A Population-Based Cohort Study
(2024) In Open Forum Infectious Diseases 11(7).- Abstract
Background. Survivors of sepsis may experience long-term risk of increased morbidity and mortality, but estimations of cause-specific effects beyond 1 year after a sepsis episode are lacking. Method. This nationwide population-based cohort study linked data from national registers to compare patients aged ≥18 years in Sweden admitted to an intensive care unit from 2008 to 2019 with severe community-acquired sepsis. Patients were identified through the Swedish Intensive Care Registry, and randomly selected population controls were matched for age, sex, calendar year, and county of residence. Confounding from comorbidities, health care use, and socioeconomic and demographic factors was accounted for by using entropy-balancing methods.... (More)
Background. Survivors of sepsis may experience long-term risk of increased morbidity and mortality, but estimations of cause-specific effects beyond 1 year after a sepsis episode are lacking. Method. This nationwide population-based cohort study linked data from national registers to compare patients aged ≥18 years in Sweden admitted to an intensive care unit from 2008 to 2019 with severe community-acquired sepsis. Patients were identified through the Swedish Intensive Care Registry, and randomly selected population controls were matched for age, sex, calendar year, and county of residence. Confounding from comorbidities, health care use, and socioeconomic and demographic factors was accounted for by using entropy-balancing methods. Long-term mortality and readmission rates, total and cause specific, were compared for 20 313 patients with sepsis and 396 976 controls via Cox regression. Results. During the total follow-up period, 56% of patients with sepsis died, as opposed to 26% of the weighted controls. The hazard ratio for all-cause mortality was attenuated with time but remained elevated in all periods: 3.0 (95% CI, 2.8–3.2) at 2 to 12 months after admission, 1.8 to 1.9 between 1 and 5 years, and 1.6 (95% CI, 1.5–1.8) at >5 years. The major causes of death and readmission among the sepsis cases were infectious diseases, cancer, and cardiovascular diseases. The hazard ratios were larger among those without underlying comorbidities. Conclusions. Severe community-acquired sepsis was associated with substantial long-term effects beyond 1 year, as measured by mortality and rehospitalization. The cause-specific rates indicate the importance of underlying or undetected comorbidities while suggesting that survivors of sepsis may face increased long-term mortality and morbidity not explained by underlying health factors.
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- author
- Inghammar, Malin LU ; Linder, Adam LU ; Lengquist, Maria LU ; Frigyesi, Attila LU ; Wetterberg, Hanna LU ; Sundén-Cullberg, Jonas and Nilsson, Anton LU
- organization
-
- Infection Medicine (BMC)
- EpiHealth: Epidemiology for Health
- Translational Sepsis research (research group)
- SEBRA Sepsis and Bacterial Resistance Alliance (research group)
- Heparin bindning protein in cardiothoracic surgery (research group)
- Anesthesiology and Intensive Care
- Intensive Care Epidemiology (research group)
- Epidemiology (research group)
- EPI@LUND (research group)
- Centre for Economic Demography
- publishing date
- 2024-07
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- epidemiology, long-term, mortality, readmission, sepsis
- in
- Open Forum Infectious Diseases
- volume
- 11
- issue
- 7
- article number
- ofae331
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85198393185
- ISSN
- 2328-8957
- DOI
- 10.1093/ofid/ofae331
- language
- English
- LU publication?
- yes
- id
- 3ba03dd8-ed32-4dac-8eaf-fdf8a202c1e5
- date added to LUP
- 2024-10-03 15:25:17
- date last changed
- 2024-10-03 15:26:36
@article{3ba03dd8-ed32-4dac-8eaf-fdf8a202c1e5, abstract = {{<p>Background. Survivors of sepsis may experience long-term risk of increased morbidity and mortality, but estimations of cause-specific effects beyond 1 year after a sepsis episode are lacking. Method. This nationwide population-based cohort study linked data from national registers to compare patients aged ≥18 years in Sweden admitted to an intensive care unit from 2008 to 2019 with severe community-acquired sepsis. Patients were identified through the Swedish Intensive Care Registry, and randomly selected population controls were matched for age, sex, calendar year, and county of residence. Confounding from comorbidities, health care use, and socioeconomic and demographic factors was accounted for by using entropy-balancing methods. Long-term mortality and readmission rates, total and cause specific, were compared for 20 313 patients with sepsis and 396 976 controls via Cox regression. Results. During the total follow-up period, 56% of patients with sepsis died, as opposed to 26% of the weighted controls. The hazard ratio for all-cause mortality was attenuated with time but remained elevated in all periods: 3.0 (95% CI, 2.8–3.2) at 2 to 12 months after admission, 1.8 to 1.9 between 1 and 5 years, and 1.6 (95% CI, 1.5–1.8) at >5 years. The major causes of death and readmission among the sepsis cases were infectious diseases, cancer, and cardiovascular diseases. The hazard ratios were larger among those without underlying comorbidities. Conclusions. Severe community-acquired sepsis was associated with substantial long-term effects beyond 1 year, as measured by mortality and rehospitalization. The cause-specific rates indicate the importance of underlying or undetected comorbidities while suggesting that survivors of sepsis may face increased long-term mortality and morbidity not explained by underlying health factors.</p>}}, author = {{Inghammar, Malin and Linder, Adam and Lengquist, Maria and Frigyesi, Attila and Wetterberg, Hanna and Sundén-Cullberg, Jonas and Nilsson, Anton}}, issn = {{2328-8957}}, keywords = {{epidemiology; long-term; mortality; readmission; sepsis}}, language = {{eng}}, number = {{7}}, publisher = {{Oxford University Press}}, series = {{Open Forum Infectious Diseases}}, title = {{Long-term Mortality and Hospital Readmissions Among Survivors of Sepsis in Sweden : A Population-Based Cohort Study}}, url = {{http://dx.doi.org/10.1093/ofid/ofae331}}, doi = {{10.1093/ofid/ofae331}}, volume = {{11}}, year = {{2024}}, }