title: Long-Term Mortality and Major Adverse Cardiovascular Events in Sepsis Survivors. A Nationwide Population-based Study.
abstract: Patients with sepsis who survive to hospital discharge may present with ongoing high morbidity and mortality. However, little is known about the risk of long-term, all-cause mortality and cardiovascular outcomes after sepsis.
  
  
  
  Our study aimed to investigate the long-term clinical outcomes in sepsis survivors.
  
  
  
  In this nationwide population-based study, data from patients with sepsis were retrieved from Taiwan's National Health Insurance Research Database between 2000 and 2002. Each sepsis survivor was 1:1 propensity-matched to control subjects from two different control populations: subjects who were in the general population and subjects who were hospitalized for a nonsepsis diagnosis. The primary outcomes were all-cause mortality, major adverse cardiovascular events, myocardial infarction, heart failure, stroke, and sudden cardiac death or ventricular arrhythmia.
  
  
  
  Compared with matched population control subjects, sepsis survivors had higher risks of all-cause mortality (hazard ratio [HR], 2.18; 95% confidence interval [CI], 2.14-2.22), major adverse cardiovascular events (HR, 1.37; 95% CI, 1.34-1.41), ischemic stroke (HR, 1.27; 95% CI, 1.23-1.32), hemorrhagic stroke (HR, 1.36; 95% CI, 1.26-1.46), myocardial infarction (HR, 1.22; 95% CI, 1.14-1.30), heart failure (HR, 1.48; 95% CI, 1.43-1.53), and sudden cardiac death or ventricular arrhythmia (HR, 1.65; 95% CI, 1.57-1.74). Similar results, although slightly attenuated risks, were found when comparisons were made with hospitalized control subjects without sepsis.
  
  
  
  These data indicate that sepsis survivors had substantially increased risks of subsequent all-cause mortality and major adverse cardiovascular events at 1 year after discharge, which persisted for up to 5 years after discharge.
authors.affiliation: 1 Division of Nephrology, Department of Medicine.|2 School of Medicine, National Yang-Ming University, Taipei, Taiwan.|3 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.affiliation: 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan.|4 Department of Chest, and.
authors.forename: Hsi
authors.initials: H
authors.lastname: Chu
authors.affiliation: 5 College of Medicine and.|6 Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Chao
authors.affiliation: 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan.|7 Department of Neurology, Taipei City Hospital, Ren Ai Branch, Taipei, Taiwan.
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: 9 Division of Infectious Diseases, and.|2 School of Medicine, National Yang-Ming University, Taipei, Taiwan.|8 National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: 10 Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan.|11 Division of Respiratory Therapy, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan.
authors.forename: Ching-Min
authors.initials: CM
authors.lastname: Tseng
authors.affiliation: 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan.|12 Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan; and.|13 Deran Clinic, Yilan, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Shih
authors.affiliation: 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan.|14 Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D017741:Survivors / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology
keywords: epidemiology; heart failure; major adverse cardiovascular events; mortality; sepsis