Half of all patients with sepsis admitted to an emergency medical department died within two years, according to Danish researchers investigating factors that could predict outcomes for these patients.
Dr. Finn E. Nielsen, a senior scientist in the Department of Clinical Epidemiology at Aarhus University Hospital, Denmark, told the European Emergency Medicine Congress today (Tuesday) that he and his colleagues examined deaths over a long follow-up period in a prospective study of 714 adult patients admitted to the emergency department with sepsis. Their findings revealed several risk factors associated with sepsis-related deaths.
"We found that certain factors increased the risk of death after sepsis, including, not surprisingly, advanced age. Additionally, conditions such as dementia, heart disease, cancer and previous hospitalization with sepsis within the last six months before admission also elevated the risk of dying during a median follow-up period of two years," he said.
In a report in 2020, the World Health Organization (WHO) highlighted limitations and gaps in knowledge about sepsis outcomes, with existing studies having a mixture of designs, differences in data sources, and different definitions of sepsis, all of which produced considerable variations in estimates of incidence and deaths from the condition. The WHO called for prospective studies to investigate long-term outcomes for sepsis patients.
Dr. Nielsen, who is a specialist in emergency medicine, cardiology and internal medicine, established the sepsis research group in his emergency department in 2017. The current study examined outcomes among patients admitted with sepsis between October 2017 and the end of March 2018.
"Our study relied on a sepsis database, which provided valuable information based on prospectively collected patient data. Unlike frequently used routine registry data, this approach minimised errors, and allowed for more accurate and detailed insights into sepsis effects."
A total of 2,110 patients with suspected infections were included in the study, of whom 714 developed sepsis. The researchers obtained data on deaths from the Danish registry systems, which provide up-to-date information on all Danish citizens. They found that after a median of two years, 361 (50.6%) of the patients with sepsis had died from any cause, including sepsis. Older age increased the risk of death by 4% for every additional year of age.
Furthermore, a history of cancer more than doubled the risk (121%), ischaemic heart disease (a condition in which the arteries supplying blood to the heart narrow or become blocked by a build-up of fat) increased the risk by 39%, dementia increased the risk by 90%, and previous admission with sepsis within the last six months increased the risk by 48%.
"Our study identifies several risk factors that should be prioritised by medical staff for information, care and follow-up checks. We believe this knowledge is useful for both clinicians and researchers in the field of acute medicine," said Dr Nielsen. "Recognising that sepsis is a serious illness with high mortality is crucial."
As the study was carried out in a single centre, further research in larger, prospective studies is needed.
"In this study, we have attempted to address some of the gaps in our understanding of sepsis epidemiology. We have contributed with an investigation that, unlike many other studies, is based on prospective electronic health record-based research. Similar but larger studies of sepsis-related outcomes need to be repeated across departments, regions and countries to obtain a comprehensive epidemiological picture of sepsis, including the long-term prognostic aspects of physical, mental and cognitive disorders, and the potential impact of these factors on the risk of death," he said.
Dr. Nielsen and his colleagues tried to develop a model that could predict the risk of death over the longer term but found that its predictive power was not good enough.
"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," he said. "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."
We will be presenting supplementary data to the conference. Including a score for organ failure in a more complex model has improved the ability to predict the risk of long-term death after hospitalisation. This has potential applications in clinical practice and future research."
Dr. Finn E. Nielsen, Senior Scientist, Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
Dr. Barbra Backus is chair of the EUSEM abstract selection committee. She is an emergency physician in Rotterdam, The Netherlands, and was not involved with the research. She said: "Sepsis is a serious and potentially fatal medical condition. The incidence of sepsis is increasing in several countries, yet so far, there has been limited, reliable information about long-term outcomes for patients who develop sepsis. This study has shown certain risk factors that should alert clinicians to the risk of patients with sepsis at an increased risk of dying, so that they can monitor them and follow them up more closely. More research is needed to help us better understand the risk factors for an increased risk of dying from sepsis, which can help to improve treatment."
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