Predictors of Long-term Mortality After Severe Sepsis in the Elderly

Background: Mortality rates after severe sepsis are extremely high, and the main focus of most research is short-term mortality, which may not be associated with long-term outcomes. The purpose of this study was to examine long-term mortality after a severe sepsis and identify factors associated with this mortality. Methods: The authors performed a population-based study using Veterans' Affairs administrative data of patients aged 65 years and older. The outcome of interest was mortality > 90 days following hospitalization. Our primary analyses were Cox proportional hazard models to examine specific risk factors for long-term mortality. Results: There were 2,727 patients that met the inclusion criteria. Overall mortality was 55%, and 1- and 2-year mortality rates were 31% and 43%, respectively. Factors significantly associated with long-term mortality included congestive heart failure, peripheral vascular disease, dementia, diabetes with complications and use of mechanical ventilation. Smoking cessation and cardiac medications were associated with decreased long-term mortality rates. Conclusions: The authors identified several factors, including receipt of mechanical ventilation, which were significantly associated with increased long-term mortality for survivors of severe sepsis. This information will help clinicians discuss prognosis with patients and their families.