Half of all patients with sepsis admitted to a medical emergency department died within two years, according to Danish researchers who examined factors that could predict outcomes for these patients.
Dr. Finn E. Nielsen, a senior scientist at the Department of Clinical Epidemiology at Aarhus University Hospital, Denmark, told the European Emergency Medicine Congress today (Tuesday) that he and his colleagues have reported deaths over a long follow-up period in a prospective study investigated. 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. In addition, conditions such as dementia, heart disease, cancer, and previous hospitalizations with sepsis in the last six months before admission also increased the risk of death during a median follow-up period of two years.he said.
In a 2020 report, the World Health Organization (WHO) highlighted the limitations and gaps in knowledge about sepsis outcomes, with existing studies having a mix of designs, differences in data sources and different definitions of sepsis, all of which yielded significant variations in outcomes of sepsis. estimates of the incidence and deaths from the condition. The WHO called for prospective studies to investigate long-term outcomes for sepsis patients.
Dr. Nielsen, a specialist in emergency medicine, cardiology and internal medicine, founded the sepsis research group in his emergency department in 2017. The current study examined the outcomes of patients admitted with sepsis between October 2017 and the end of March 2018.
“Our study was based on a sepsis database, which provided valuable information from prospectively collected patient data. Unlike commonly used routine registry data, this approach minimized errors and provided more accurate and detailed insights into the effects of sepsis.”
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 registration systems, which provide up-to-date information on all Danish citizens. They found that after an average of two years, 361 (50.6%) of patients with sepsis had died from any cause, including sepsis. Older age increased the risk of death by 4% for each additional year of age.
Furthermore, a history of cancer more than doubled the risk (121%); ischemic heart disease (a condition in which the arteries that supply blood to the heart narrow or become blocked by a buildup of fat) increased the risk by 39%, dementia increased the risk by 90%, and previous hospitalization with sepsis within the past six months increased the risk by 48%.
“Our study identifies several risk factors that should be prioritized by healthcare professionals for information, care and follow-up. We believe this knowledge is useful for both physicians and researchers in the field of acute medicine,” said Dr. Nielsen. “It is critical that we recognize that sepsis is a serious disease with high mortality.”
Because the study was conducted in a single center, further research in larger, prospective studies is needed.
“In this study, we sought to address some of the gaps in our understanding of the epidemiology of sepsis. We contributed with a study that, unlike many other studies, is based on prospective research using electronic health records. Similar but larger studies of sepsis-related outcomes need to be replicated across departments, regions and countries to obtain a comprehensive epidemiological picture of sepsis, including the long-term prognostic aspects of physical, mental and cognitive impairment, and the potential impact of these factors on risk on death,” he said.
Dr. Nielsen and his colleagues tried to develop a model that could predict the risk of death in 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 a general model suitable for predicting mortality.” in clinical practice,” he said. “There is a need for prospective studies on the effect of other factors not examined in our study, including various complications that may occur after hospital admission and after discharge.”
We will present additional data at the conference. Including an organ failure score in a more complex model has improved the ability to predict the risk of long-term mortality after hospital admission. 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, Netherlands, and was not involved in the study. She said: “Sepsis is a serious and potentially fatal medical condition. The incidence of sepsis is increasing in several countries, but to date there is limited, reliable information on the long-term outcomes for patients who develop sepsis. This study has identified certain risk factors that should alert physicians that patients with sepsis are at increased risk of death so that they can monitor and follow up more closely. More research is needed to help us better understand the risk factors for increased risk of dying from sepsis, which could help improve treatment.”