Sepsis Plays a Role in Late Deaths, Data Suggests

Findings are mixed on whether the sepsis itself or a pre-existing health problem are driving the elevated mortality rate, but suggest that "long-term mortality after sepsis could be more amenable to intervention than previously thought."

Sepsis, a dangerous outcome triggered by an infection, can be fast-moving, debilitating, and fatal.

Now researchers are finding that even those who survive tissue damage and organ failure caused by sepsis can have a higher risk of "late death," defined as mortality within two years of being treated for the condition.

Researchers at the University of Michigan Health System are generating new data on the causes sepsis-related of late death, but it is unclear whether the sepsis itself or a pre-existing health problem is driving the elevated mortality rate.  

Adapting to the CMS Sepsis Bundle

A study in the current issue of the BMJ suggests that pre-existing conditions alone do not account for late death. The findings suggest that "long-term mortality after sepsis could be more amenable to intervention than previously thought," according to the study.

Researchers found that compared to the patients admitted to the hospital with a non-sepsis infection, patients with sepsis had a 10% absolute increase in late death.

The study also found a 16% absolute increase in late death among sepsis patients compared to those admitted with sterile inflammatory conditions. Sepsis was also associated with a 22% absolute increase in late mortality relative to similar, hospitalized adults.

"Taken together, our findings do not refute the importance of baseline burden of comorbidity to patients' long term outcomes after sepsis. They do, however, indicate that sepsis confers an additional risk of late mortality above and beyond that predicted by status before sepsis alone," the researchers wrote.

The incidence of sepsis among hospitals patients has risen from 621,000 in 2000 to 1,141,000 in 2008, according to the latest figures available from the Centers for Disease Control and Prevention.

High Cost in Lives and Dollars

In 2009, the cost of hospital care for sepsis was an estimated $15.4 billion. Between 1997 through 2008, costs for treating patients hospitalized for sepsis increased by an average of 11.9% each year. Efforts are underway to promote early diagnosis and treatment of the condition.  

In order to explore the question of whether the elevated mortality is linked to the sepsis or underlying conditions, the researchers analyzed medical records from the University of Michigan's Health and Retirement Study (HRS), a long-term national study of more than 20,000 older Americans.

They found that one in five older patients who survives sepsis has a late death not explained by pre-sepsis health status.

"This suggests that more than one in five patients who survives sepsis dies acutely within the next two years as a consequence of sepsis. Compared with patients admitted to hospital with non-sepsis infection or sterile inflammatory conditions, patients with sepsis experienced a 10% increase in late mortality—or roughly one in 10 had a late death related to sepsis," according to the study.

Sepsis is also a major cause of hospital readmissions and ongoing research is looking at risk factors. A 2015 study found 30-day readmission rates for sepsis for one in five patients in California.