Occurrence and Risk Factors for New Dependency on Chronic Care, Respiratory Support, Dialysis and Mortality in the First Year After Sepsis

Melissa Spoden; Christiane S Hartog; Peter Schlattmann; Antje Freytag; Marlies Ostermann; Lisa Wedekind; Josephine Storch; Konrad Reinhart; Christian Günster; Carolin Fleischmann-Struzek

doi:10.3389/fmed.2022.878337

Occurrence and Risk Factors for New Dependency on Chronic Care, Respiratory Support, Dialysis and Mortality in the First Year After Sepsis

Front Med (Lausanne). 2022 May 19:9:878337. doi: 10.3389/fmed.2022.878337. eCollection 2022.

Authors

Affiliations

¹ Research Institute of the Local Health Care Funds (AOK), Berlin, Germany.
² Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
³ Klinik Bavaria, Kreischa, Germany.
⁴ Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany.
⁵ Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.
⁶ Department of Critical Care, King's College London, Guy's and St Thomas' Hospital, London, United Kingdom.
⁷ Center for Sepsis Control and Care, Jena University Hospital/Friedrich Schiller University Jena, Jena, Germany.
⁸ Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.

Abstract

Sepsis survival is associated with adverse outcomes. Knowledge about risk factors for adverse outcomes is lacking. We performed a population-based cohort study of 116,507 survivors of hospital-treated sepsis identified in health claims data of a German health insurance provider. We determined the development and risk factors for long-term adverse events: new dependency on chronic care, chronic dialysis, long-term respiratory support, and 12-month mortality. At-risk patients were defined by absence of these conditions prior to sepsis. Risk factors were identified using simple and multivariable logistic regression analyses. In the first year post-sepsis, 48.9% (56,957) of survivors had one or more adverse outcome, including new dependency on chronic care (31.9%), dialysis (2.8%) or respiratory support (1.6%), and death (30.7%). While pre-existing comorbidities adversely affected all studied outcomes (>4 comorbidities: OR 3.2 for chronic care, OR 4.9 for dialysis, OR 2.7 for respiratory support, OR 4.7 for 12-month mortality), increased age increased the odds for chronic care dependency and 12-month mortality, but not for dialysis or respiratory support. Hospital-acquired and multi-resistant infections were associated with increased risk of chronic care dependency, dialysis, and 12-month mortality. Multi-resistant infections also increased the odds of respiratory support. Urinary or respiratory infections or organ dysfunction increased the odds of new dialysis or respiratory support, respectively. Central nervous system infection and organ dysfunction had the highest OR for chronic care dependency among all infections and organ dysfunctions. Our results imply that patient- and infection-related factors have a differential impact on adverse life changing outcomes after sepsis. There is an urgent need for targeted interventions to reduce the risk.

Keywords: long-term mortality; occurrence; post-sepsis syndrome; risk factors; sepsis.