One-year outcomes in sepsis: a prospective multicenter cohort study in Japan

doi:10.1186/s40560-025-00792-0

. 2025 May 1;13(1):23.

doi: 10.1186/s40560-025-00792-0.

One-year outcomes in sepsis: a prospective multicenter cohort study in Japan

Keibun Liu^#^{1

2}, Shinichi Watanabe^#^{3

4}, Kensuke Nakamura^{5

6}, Hidehiko Nakano⁶, Maiko Motoki⁶, Hiroshi Kamijo⁷, Matsuoka Ayaka⁸, Kenzo Ishii⁹, Yasunari Morita¹⁰, Takashi Hongo^{11

12}, Nobutake Shimojo¹³, Yukiko Tanaka¹⁴, Manabu Hanazawa¹⁵, Tomohiro Hamagami¹⁶, Kenji Oike¹⁷, Daisuke Kasugai¹⁸, Yutaka Sakuda¹⁹, Yuhei Irie²⁰, Masakazu Nitta²¹, Kazuki Akieda²², Daigo Shimakura²³, Hajime Katsukawa²⁴, Toru Kotani²⁵, David McWilliams^{26

27}, Peter Nydahl^{28

29}, Stefan J Schaller^{30

31}, Takayuki Ogura³²; ILOSS Study Group

Affiliations

¹ Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan. keiliu0406@gmail.com.
² , 2-15-13 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan. keiliu0406@gmail.com.
³ Department of Physical Therapy, Gifu University of Health Science, Gifu, Japan.
⁴ Department of Rehabilitation, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan.
⁵ Department of Critical Care Medicine, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
⁶ Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan.
⁷ Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan.
⁸ Department of Emergency and Critical Care Medicine Faculty, Saga University Hospital, Saga, Saga, Japan.
⁹ Department of Anesthesiology, Intensive Care Unit, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan.
¹⁰ Department of Emergency and Intensive Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan.
¹¹ Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Okayama Kita-Ku, Okayama, 700-8558, Japan.
¹² Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutaityo, Okayama Kita-Ku, Okayama, 700-8511, Japan.
¹³ Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
¹⁴ Department of Emergency, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.
¹⁵ Department of Rehabilitation, Japan Red Cross Narita Hospital, Narita, Chiba, Japan.
¹⁶ Tajima Emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Hyogo, Japan.
¹⁷ Department of Rehabilitation, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
¹⁸ Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
¹⁹ Department of Intensive Care Medicine, Okinawa Kyodo Hospital, Naha, Okinawa, Japan.
²⁰ Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan.
²¹ Department of Intensive Care Unit, Niigata University Medical and Dental Hospital, Niigata, Niigata, Japan.
²² Department of Emergency Medicine, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan.
²³ Graduate School of Data Science, Shiga University, Shiga, Japan.
²⁴ Japanese Society for Early Mobilization, Tokyo, Japan.
²⁵ Showa Medical University, Shinagawa, Tokyo, Japan.
²⁶ Centre for Care Excellence, Coventry University, Coventry, UK.
²⁷ Critical Care, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
²⁸ Nursing Research, University Hospital Schleswig-Holstein, Kiel, Germany.
²⁹ Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
³⁰ Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anesthesia and Intensive Care Medicine, Medical University of Vienna, Wien, Austria.
³¹ Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin, Berlin, Germany.
³² Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.

^# Contributed equally.

PMID: 40307943
PMCID: PMC12044722
DOI: 10.1186/s40560-025-00792-0

One-year outcomes in sepsis: a prospective multicenter cohort study in Japan

Keibun Liu et al. J Intensive Care. 2025.

. 2025 May 1;13(1):23.

doi: 10.1186/s40560-025-00792-0.

Authors

Affiliations

¹ Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan. keiliu0406@gmail.com.
² , 2-15-13 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan. keiliu0406@gmail.com.
³ Department of Physical Therapy, Gifu University of Health Science, Gifu, Japan.
⁴ Department of Rehabilitation, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan.
⁵ Department of Critical Care Medicine, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
⁶ Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan.
⁷ Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, Nagano, Japan.
⁸ Department of Emergency and Critical Care Medicine Faculty, Saga University Hospital, Saga, Saga, Japan.
⁹ Department of Anesthesiology, Intensive Care Unit, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan.
¹⁰ Department of Emergency and Intensive Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan.
¹¹ Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-Cho, Okayama Kita-Ku, Okayama, 700-8558, Japan.
¹² Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutaityo, Okayama Kita-Ku, Okayama, 700-8511, Japan.
¹³ Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
¹⁴ Department of Emergency, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.
¹⁵ Department of Rehabilitation, Japan Red Cross Narita Hospital, Narita, Chiba, Japan.
¹⁶ Tajima Emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Hyogo, Japan.
¹⁷ Department of Rehabilitation, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
¹⁸ Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
¹⁹ Department of Intensive Care Medicine, Okinawa Kyodo Hospital, Naha, Okinawa, Japan.
²⁰ Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan.
²¹ Department of Intensive Care Unit, Niigata University Medical and Dental Hospital, Niigata, Niigata, Japan.
²² Department of Emergency Medicine, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan.
²³ Graduate School of Data Science, Shiga University, Shiga, Japan.
²⁴ Japanese Society for Early Mobilization, Tokyo, Japan.
²⁵ Showa Medical University, Shinagawa, Tokyo, Japan.
²⁶ Centre for Care Excellence, Coventry University, Coventry, UK.
²⁷ Critical Care, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.
²⁸ Nursing Research, University Hospital Schleswig-Holstein, Kiel, Germany.
²⁹ Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
³⁰ Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Clinical Division of General Anesthesia and Intensive Care Medicine, Medical University of Vienna, Wien, Austria.
³¹ Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin, Berlin, Germany.
³² Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.

^# Contributed equally.

PMID: 40307943
PMCID: PMC12044722
DOI: 10.1186/s40560-025-00792-0

Erratum in

Correction: One-year outcomes in sepsis: a prospective multicenter cohort study in Japan.
Liu K, Watanabe S, Nakamura K, Nakano H, Motoki M, Kamijo H, Ayaka M, Ishii K, Morita Y, Hongo T, Shimojo N, Tanaka Y, Hanazawa M, Hamagami T, Oike K, Kasugai D, Sakuda Y, Irie Y, Nitta M, Akieda K, Shimakura D, Katsukawa H, Kotani T, McWilliams D, Nydahl P, Schaller SJ, Ogura T; ILOSS Study Group. Liu K, et al. J Intensive Care. 2025 May 22;13(1):28. doi: 10.1186/s40560-025-00799-7. J Intensive Care. 2025. PMID: 40405308 Free PMC article. No abstract available.

Abstract

Background: Sepsis is a leading cause of death in intensive care units (ICU). Sepsis survivors are often left with significant morbidity, termed post-intensive care syndrome (PICS), impacting post-sepsis life. The aim was to present detailed data on the prognostic and functional long-term outcomes of ICU patients with sepsis in Japan, which is currently lacking and therefore prevents development of targeted solutions.

Methods: A multicenter prospective study, involving 21 ICUs in 20 tertiary hospitals in Japan, included all consecutive adult ICU patients between November 2020 and April 2022, and diagnosed with sepsis at ICU admission (Sepsis 3). Follow-ups were performed at 3, 6, and 12 months after hospital discharge by telephone and mail. Primary outcome was death or incidence of PICS, defined by any of physical dysfunction (Barthel Index ≤ 90), cognitive dysfunction (Short Memory Questionnaire < 40), or mental disorder (any subscales for anxiety or depression of Hospital Anxiety and Depression Scale ≥ 8, or Impact of Event Scale-Revised ≥ 25). Secondary outcomes included Quality of Life (QOL), employment, and use of hospital, emergency, rehabilitation, and psychiatric services. A multivariable analysis investigated independent factors associated with each dysfunction at each follow-up.

Results: A total of 339 patients were included (median age 74 [67-82] years, 60% male, 77% septic shock, and a median SOFA of 9 [6-12]). Mortality was 23% at hospital discharge, increasing to 37% at 12 months. The rate of death for those who met PICS Criteria at hospital discharge was 89%, with a death or PICS incidence of 73%, 64%, and 65% at 3, 6, and 12 months, respectively. Limited improvements in QOL and return to work (44%), high rates of hospital readmissions (40%), frequent emergency service usage (31%), and low utilization of rehabilitation and psychiatric services (15% and 7%) were identified over the first year. The incidence of any PICS-related dysfunction was consistently an independent factor for the incidence of the same dysfunction at the following follow-ups.

Conclusions: This multicenter study identified the distinct realities of post-sepsis life in Japanese ICU patients, highlighting the unique challenges in improving their functions and returning to daily life. Trial Registration University Hospital Medical Information Network UMIN000041433.

Keywords: Intensive care unit; Morbidity; Mortality; Post-intensive care syndrome; Quality of life; Sepsis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study received ethics approvals from Saiseikai Utsunomiya Hospital (2020–42) and all other participating institutions. It was registered in the University Hospital Medical Information Network Clinical Trials Registry (Trial registration number: UMIN 000041433), and informed consent was obtained from all patients. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Patient flow chart. COVID-19: Coronavirus disease 2019, *ICU* Intensive Care Unit

**Fig. 2**
Primary outcome of the death or incidence of PICS. *PICS* Post Intensive Care Syndrome

See this image and copyright information in PMC

Cited by

Correction: One-year outcomes in sepsis: a prospective multicenter cohort study in Japan.
Liu K, Watanabe S, Nakamura K, Nakano H, Motoki M, Kamijo H, Ayaka M, Ishii K, Morita Y, Hongo T, Shimojo N, Tanaka Y, Hanazawa M, Hamagami T, Oike K, Kasugai D, Sakuda Y, Irie Y, Nitta M, Akieda K, Shimakura D, Katsukawa H, Kotani T, McWilliams D, Nydahl P, Schaller SJ, Ogura T; ILOSS Study Group. Liu K, et al. J Intensive Care. 2025 May 22;13(1):28. doi: 10.1186/s40560-025-00799-7. J Intensive Care. 2025. PMID: 40405308 Free PMC article. No abstract available.
Long-term mental health change patterns in ICU survivors: a four-year comparative follow-up from the SMAP-HoPe study.
Unoki T, Kuribara T, Uemura S, Hino M, Shirasaka M, Misu Y, Nagao T, Kitayama M, Haruna J, Yamane M, Atsumi K, Sagawa M, Kajiyama Y, Okada K, Nishide T, Higuchi E, Sakuramoto H. Unoki T, et al. J Intensive Care. 2025 Jul 28;13(1):41. doi: 10.1186/s40560-025-00812-z. J Intensive Care. 2025. PMID: 40721824 Free PMC article.

References

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1. Meyer NJ, Prescott HC. Sepsis and septic shock. N Engl J Med. 2024;391:2133–46. - PubMed
1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of disease study. Lancet. 2020;395:200–11. - PMC - PubMed
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[1] Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840–51. - PubMed

[2] Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840–51. - PubMed

[3] Meyer NJ, Prescott HC. Sepsis and septic shock. N Engl J Med. 2024;391:2133–46. - PubMed

[4] Meyer NJ, Prescott HC. Sepsis and septic shock. N Engl J Med. 2024;391:2133–46. - PubMed

[5] Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of disease study. Lancet. 2020;395:200–11. - PMC - PubMed

[6] Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of disease study. Lancet. 2020;395:200–11. - PMC - PubMed

[7] Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–16. - PubMed

[8] Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–16. - PubMed

[9] Shankar-Hari M, Rubenfeld GD. Understanding long-term outcomes following sepsis: implications and challenges. Curr Infect Dis Rep. 2016;18:37. - PMC - PubMed

[10] Shankar-Hari M, Rubenfeld GD. Understanding long-term outcomes following sepsis: implications and challenges. Curr Infect Dis Rep. 2016;18:37. - PMC - PubMed

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One-year outcomes in sepsis: a prospective multicenter cohort study in Japan

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One-year outcomes in sepsis: a prospective multicenter cohort study in Japan

Authors

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Abstract

Conflict of interest statement

Figures

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References

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