Clinical Investigation
Predictors of Long-term Mortality After Severe Sepsis in the Elderly

https://doi.org/10.1097/MAJ.0b013e318295a147Get rights and content

Abstract

Background

Mortality rates after severe sepsis are extremely high, and the main focus of most research is short-term mortality, which may not be associated with long-term outcomes. The purpose of this study was to examine long-term mortality after a severe sepsis and identify factors associated with this mortality.

Methods

The authors performed a population-based study using Veterans’ Affairs administrative data of patients aged 65 years and older. The outcome of interest was mortality > 90 days following hospitalization. Our primary analyses were Cox proportional hazard models to examine specific risk factors for long-term mortality.

Results

There were 2,727 patients that met the inclusion criteria. Overall mortality was 55%, and 1- and 2-year mortality rates were 31% and 43%, respectively. Factors significantly associated with long-term mortality included congestive heart failure, peripheral vascular disease, dementia, diabetes with complications and use of mechanical ventilation. smoking cessation and cardiac medications were associated with decreased long-term mortality rates.

Conclusions

The authors identified several factors, including receipt of mechanical ventilation, which were significantly associated with increased long-term mortality for survivors of severe sepsis. This information will help clinicians discuss prognosis with patients and their families.

Section snippets

METHODS

Our study used data from the administrative databases of the Department of VA health care systems. The data were a collection of clinical data from all of the VA hospitals and outpatient clinics. The institutional Review Board of the University of Texas Health Science Center at San Antonio approved this study under expedited review. Waiver of informed consent was obtained for this study.

Patient Characteristics

A total of 2,727 patients met the criteria to be included in this study. We identified 7,302 hospitalizations due to severe sepsis that received antibiotic treatment within the 1st 48 hours of admission (Figure 1). Of those, we excluded the 4,411 patients who died within 90 days of hospital admission and 164 episodes that were rehospitalizations. Of those who meet the inclusion criteria, 1,501 (55%) died during the follow-up period. Our cohort was largely men (98.5%), with an average age of 76

DISCUSSION

Sepsis is a disease of great importance to clinicians, but long-term effects of a severe sepsis diagnosis have been studied only superficially. This study builds on the small number of prior papers that examined the long-term effects of severe sepsis and found associations between long-term mortality and factors such as age, multiple comorbid conditions, mechanical ventilation, medication use and smoking cessation. This study is important because it highlights the long-term effects of severe

CONCLUSIONS

In conclusion, there is substantial long-term mortality after severe sepsis and care should not end after discharge from the hospital, especially for patients with the risk factors for long-term mortality. Clinicians should closely monitor those who survive the initial hospitalization for severe sepsis so as to identify factors that may be potentially modifiable. In addition, this information should be provided to patients and their families so as to help them understand the natural history of

REFERENCES (25)

  • H. Korosec Jagodic et al.

    Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma

    Crit Care

    (2006)
  • D.C. Angus et al.

    Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care

    Crit Care Med

    (2001)
  • Cited by (0)

    This study was supported by the National Institute of Nursing Research Grant R01NR010828.

    The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System. Funding agencies had no role in conducting the study or role in the preparation, review or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

    The authors have no financial or other conflicts of interest to disclose.

    View full text