title: Predictors of long-term mortality after severe sepsis in the elderly.
abstract: 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.
authors.affiliation: VERDICT research program, and South Texas Veterans Health Care System, Audie L. Murphy Division (MIR, EMM), University of Texas Health Science Center at San Antonio, San Antonio, Texas; and Divisions of Hospital Medicine (ACL, EMM) and Pulmonary/Critical Care Medicine (MIR, AA), Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Allyson C
authors.initials: AC
authors.lastname: Lemay
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D003704:Dementia / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006760:Hospitalization; D006801:Humans; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000401:mortality*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs