Trends in mortality after a sepsis hospitalization: A nationwide prospective registry study from 2008-2021

Abstract

Abstract Background Few studies have reported on mortality beyond one year after sepsis. We aim to describe trends in short- and long-term mortality among patients admitted with sepsis, and to identify clinical characteristics associated with mortality for improved monitoring, treatment and prognosis. Methods Patients ≥ 18 years admitted to all Norwegian hospitals (2008–2021) with a first sepsis episode were identified using Norwegian Patient Registry and International Classification of Diseases 10th Revision codes. Sepsis was classified as implicit (known infection site plus organ dysfunction), explicit (unknown infection site), or COVID-19 related sepsis. The outcome was all-cause mortality. We calculated age-standardized 30-day, 90-day, 1-, 5- and 10-year mortality for each admission year and estimated the annual percentage change with 95% confidence interval (CI). The association between clinical characteristics and all-cause mortality is reported as hazard ratios (HRs) from Cox regression. Results The study included 222,832 patients, of whom 127,059 (57.1%) had implicit, 92,928 (41.7%) had explicit, and 2,845 (1.3%) had COVID-19-related sepsis. Trends in overall age-standardized 30-day, 90-day, 1- and 5-year mortality decreased by 0.29 (95% CI -0.39 to -0.19), 0.43 (95% CI -0.56 to -0.29), 0.61 (95% CI -0.73 to -0.49) and 0.66 (95% CI -0.84 to -0.48) percent per year, respectively. The decrease was observed for all infections sites but was largest among patients with respiratory tract infections. Implicit, explicit and COVID-19-related sepsis had largely similar overall mortality, with explicit sepsis having a HR of 0.980 (95% CI 0.969 to 0.991) and COVID-19-related sepsis a HR of 0.916 (95% CI 0.836 to 1.003) compared to implicit sepsis. Patients with respiratory tract infections have somewhat higher mortality than those with other infection sites. Number of comorbidities was positively associated with mortality, but mortality varied considerably between different comorbidities. Similarly, number of acute organ dysfunctions was strongly associated with mortality, whereas the risk varied for each type of organ dysfunction. Conclusion Overall mortality has declined over the past 14 years among patients with a first sepsis admission. Existing comorbidity, site of infection, and acute organ dysfunction are characteristics associated with mortality and needs further attention to reduce the excess risk of long-term mortality.