Article Text

Long-term mortality after community-acquired sepsis: a longitudinal population-based cohort study
  1. Henry E Wang1,
  2. Jeff M Szychowski2,
  3. Russell Griffin3,
  4. Monika M Safford4,
  5. Nathan I Shapiro5,
  6. George Howard2
  1. 1Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA
  2. 2Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
  4. 4Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA
  5. 5Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Henry E Wang; hwang{at}


Objective Prior studies have concentrated on the acute short-term outcomes of sepsis, with little focus on its long-term consequences. The objective of this study was to characterise long-term mortality following a sepsis event.

Design Population-based data from the 30 239 community-dwelling individuals in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort.

Setting USA.

Participants Community-dwelling adults ≥45 years of age. Sepsis was defined as hospitalisation or emergency department treatment for a serious infection with the presence of ≥2 systemic inflammatory response syndrome criteria.

Outcomes 6-year all-cause mortality. The analysis utilised a time-varying Cox model adjusted for participant's age, demographic factors, health behaviours and chronic medical conditions.

Results The participants were observed for a median of 6.1 years (IQR 4.5–7.1). During this period, 975 individuals experienced a sepsis event. Sepsis hospital mortality was 8.9%. One-year, 2-year and 5-year all-cause mortality among individuals with sepsis were 23%, 28.8% and 43.8%, respectively, compared with death rates of 1%, 2.6% and 8.3% among those who never developed sepsis. On multivariable analysis, the association of sepsis with increased all-cause mortality persisted for up to 5 years, after adjustment for confounders; year 0.00–1.00, adjusted HR (aHR) 13.07 (95% CI 10.63 to 16.06); year 1.01–2.00 aHR 2.64 (1.85 to 3.77); year 2.01–3.00 aHR 2.18 (1.43 to 3.33); year 3.01–4.00 aHR 1.97 (1.19 to 3.25); year 4.01–5.00 aHR 2.08 (1.14 to 3.79); year 5.01+ aHR 1.41 (0.67 to 2.98).

Conclusions Individuals with sepsis exhibited increased rates of death for up to 5 years after the illness event, even after accounting for comorbidities. Sepsis is independently associated with increased risk of mortality well after hospital treatment.

  • Epidemiology
  • Infectious Diseases

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