Late mortality after sepsis: propensity matched cohort study

作者：Hallie C. Prescott, John J. Osterholzer, Kenneth M. Langa, Derek C. Angus, Theodore John Iwashyna · 发表于：BMJ · 年份：2016 · DOI：10.1136/bmj.i2375 · 被引用次数：340 · 研究领域：Sepsis Diagnosis and Treatment、Intensive Care Unit Cognitive Disorders、Nosocomial Infections in ICU

OBJECTIVES: To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself. DEIGN: Observational cohort study. SETTING: US Health and Retirement Study. PARTICIPANTS: 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions. MAIN OUTCOME MEASURES: Late (31 days to two years) mortality and odds of death at various intervals. RESULTS: Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital. CONCLUSIONS: More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.