Long-term (10-year) mortality of younger previously healthy patients with severe sepsis/septic shock is worse than that of patients with nonseptic critical illness and of the general population

Abstract

Objectives: Long-term (1- to 10-year) outcomes after severe sepsis in previously healthy persons are unknown. We aimed to determine the 1- to 10-year mortality rates of previously healthy patients with severe sepsis and compare these to mortality rates of patients with nonseptic critical illness and the general population.

Design: A prospective cohort study of 2,289 patients from one mixed medical-surgical ICU and one cardiovascular surgery ICU. Age- and gender-comparable general British Columbia population was used as comparison. Patients were followed from the date of admission to the ICU to January 31, 2013. Provincial vital statistics were used to determine the patients' date of death. For the general population comparison, expected survival was obtained from life tables of the population of British Columbia, Canada.

Setting: A quaternary-level provincial referral hospital in Vancouver, British Columbia, Canada.

Patients: Two thousand two hundred eighty-nine patients from one mixed medical-surgical ICU and one cardiovascular surgery ICU. Age- and gender-comparable general British Columbia population was used for comparison.

Interventions: None.

Measurements and main results: Patients with severe sepsis without comorbidities had higher mortality from 1 to 10 years than general British Columbia population (p < 0.01). Younger patients with severe sepsis (< 60 yr) had the worst 1- to 5-year and 5- to 10-year mortality (hazard ratio [95% CI], 17.8 [13.4-24.8] and 6.0 [4-9]) compared with the general population. Patients with severe sepsis had significantly poorer 1- to 10-year mortality rates (30.5%) compared with patients with nonseptic critical illness (22.1%) and patients who have undergone cardiovascular surgery (15.9%). Patients with sepsis had higher mortality rates from 1-5 years and 5-10 years than the general British Columbia population (hazard ratio [95% CI], 4.5 [2.2-9.1] and 2.2 [0.9-14.7]).

Conclusions: Previously healthy patients suffering an episode of severe sepsis have increased long-term mortality compared with patients with nonseptic critical illness and a general population.