50% of Patients with Sepsis Admitted to the Emergency Department Die Within 2 years

Finn E. Nielsen

Credit: Aarhus University Hospital

Half of all patients with sepsis admitted to an emergency department died within 2 years, a recent study discovered.¹

“We found that certain factors increased the risk of death after sepsis, including, not surprisingly, advanced age,” said lead investigator Finn E. Nielsen, a senior scientist in the Department of Clinical Epidemiology at Aarhus University Hospital, Denmark, in a statement.²

A global report from the World Health Organization in 2020 recognized the knowledge gaps on epidemiology and burden of sepsis.³ Estimates of sepsis incidence and mortality differ considerably depending on study designs, data sources, and sepsis definitions.

WHO recognizes the need for improved long-term outcome data among sepsis patients. Previous sepsis epidemiological analyses are based on systematic reviews that mostly examine retrospective observational cohort or cross-sectional studies. WHO believes prospective studies using charts or electronic health records are needed to assess sepsis epidemiology.

In line with WHO’s recommendation, investigators conducted a prospective study of adult patients admitted to an emergency department with sepsis, aiming to determine long-term all-cause mortality and predictors for mortality in this patient population.¹ The findings were presented at the European Emergency Medicine Congress in Copenhagen.

The primary outcome was all-cause mortality, specifically time to death, within the long-term follow-up period. Nielson and colleagues also tried to develop a model that could predict the risk of death over the longer term.

Patients were all admitted to the emergency department with suspected infectious diseases from October 1, 2017, to March 31, 2018. The mortality data of patients were obtained from The Regional Zealand Patient Registration System, which is linked to the Danish Civil Registration System that provides daily updated information on the vital status of all Danish citizens. From another database, investigators collected data on demographics, comorbidities, triage variables, laboratory tests, infectious sources, other diagnostic procedures, and clinical progressions during hospitalization.

“Our study relied on a sepsis database, which provided valuable information based on prospectively collected patient data,” Nielson said.² “Unlike frequently used routine registry data, this approach minimised errors and allowed for more accurate and detailed insights into sepsis effects.”

The study included 2110 patients with suspected infections and 714 (33.8%) patients who developed sepsis, defined as a Sequential Organ Failure Assessment Score ≥ 2.¹ Among patients with sepsis, 58.4% were male and the median age was 75 years when sepsis developed.

After a median follow-up of 2 years, 50.6% of the patients died. Factors independently associated with the increased risk of mortality among those with sepsis included age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.03 – 1.05), a history of cancer (HR, 2.21; 95% CI, 1.70 – 2.87), ischemic heart disease (HR, 1.39; 95% CI, 1.05 – 1.85), dementia (HR, 1.90; 95% CI, 1.41 – 2.57), and previous admission with sepsis (HR, 1.48; 95% CI, 1.19 – 1.84) within the last 6 months before hospital admission.

Since this study was conducted in a single center, the team wrote how a larger prospective study needs to be carried out.

“Although we identified several risk factors that clearly increased the risk of death and should provide a focus for clinicians and researchers during the discharge planning process, as well as for developing future prediction studies, we were unable to construct an overall model suitable for predicting mortality in clinical practice,” Nielson said.² “There is a need for prospective studies of the effect of other factors that are not examined in our study, including various complications that may arise following hospitalisation and after discharge.”

References

1. ^{Abdullah, O, Andersen, L, Sorensen, R, et al. Long-term Mortality Among Sepsis Patients: A Prospective Single-Center Study. Presented at European Emergency Medicine Congress in Copenhagen on October 15, 2024, in Copenhagen, Denmark.}
2. ^{Half of All Patients with Sepsis Die Within Two Years. EurekAlert! October 14, 2024. https://www.eurekalert.org/news-releases/1060870. Accessed October 16, 2024.}
3. ^{Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. Accessed October 16, 2024.}