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. 2014 Dec 8;9(12):e112224.
doi: 10.1371/journal.pone.0112224. eCollection 2014.

Long term outcomes following hospital admission for sepsis using relative survival analysis: a prospective cohort study of 1,092 patients with 5 year follow up

Joshua S Davis  1 , Vincent He  2 , Nicholas M Anstey  1 , John R Condon  2
Affiliations

Long term outcomes following hospital admission for sepsis using relative survival analysis: a prospective cohort study of 1,092 patients with 5 year follow up

Joshua S Davis et al. PLoS One. .

Abstract

Background: Sepsis is a leading cause of death in intensive care units and is increasing in incidence. Current trials of novel therapeutic approaches for sepsis focus on 28-day mortality as the primary outcome measure, but excess mortality may extend well beyond this time period.

Methods: We used relative survival analysis to examine excess mortality in a cohort of 1,028 patients admitted to a tertiary referral hospital with sepsis during 2007-2008, over the first 5 years of follow up. Expected survival was estimated using the Ederer II method, using Australian life tables as the reference population. Cumulative and interval specific relative survival were estimated by age group, sex, sepsis severity and Indigenous status.

Results: Patients were followed for a median of 4.5 years (range 0-5.2). Of the 1028 patients, the mean age was 46.9 years, 52% were male, 228 (22.2%) had severe sepsis and 218 (21%) died during the follow up period. Mortality based on cumulative relative survival exceeded that of the reference population for the first 2 years post admission in the whole cohort and for the first 3 years in the subgroup with severe sepsis. Independent predictors of mortality over the whole follow up period were male sex, Indigenous Australian ethnicity, older age, higher Charlson Comorbidity Index, and sepsis-related organ dysfunction at presentation.

Conclusions: The mortality rate of patients hospitalised with sepsis exceeds that of the general population until 2 years post admission. Efforts to improve outcomes from sepsis should examine longer term outcomes than the traditional primary endpoints of 28-day and 90-day mortality.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1
a. Kaplan-Meier crude survival estimates by age group for all sepsis patients (n = 1,028). b. Kaplan-Meier crude survival estimates by age group for severe sepsis patients (n = 228).
Figure 2
Figure 2
a. Cumulative relative survival for patients with sepsis and severe sepsis, compared with a reference population. Dotted lines represent 95% confidence intervals. b. Cumulative relative survival for only patients with severe sepsis (n = 228), compared with a reference population. Dotted lines represent 95% confidence intervals.
Figure 3
Figure 3
a. Cumulative relative survival by age group for all sepsis patients (n = 1,028). b. Cumulative relative survival by age group for severe sepsis patients (n = 228).
See this image and copyright information in PMC

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