Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Long-term Mortality and Hospital Readmissions Among Survivors of Sepsis in Sweden : A Population-Based Cohort Study

Inghammar, Malin LU ; Linder, Adam LU ; Lengquist, Maria LU orcid ; Frigyesi, Attila LU ; Wetterberg, Hanna LU orcid ; Sundén-Cullberg, Jonas and Nilsson, Anton LU (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.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; and
organization
publishing date
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 &gt;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}},
}