title: Intermediate-term and long-term mortality among acute medical patients hospitalized with community-acquired sepsis: a population-based study.
abstract: OBJECTIVE
  Admission with severe sepsis is associated with an increased short-term mortality, but it is unestablished whether sepsis severity has an impact on intermediate-term and long-term mortality following admission to an acute medical admission unit.
  
  
  METHODS
  This was a population-based study of all adults admitted to an acute medical admission unit, Odense University Hospital, Denmark, from September 2010 to August 2011, identified by symptoms and clinical findings. We categorized the mortality periods into intermediate-term (31-180 days) and long-term (181-365, 366-730, and 731-1096 days). Mortality hazard ratios (HRs), comparing patients admitted with sepsis with those of a well-defined background population, were estimated using multivariable Cox regression. HRs were presented with 95% confidence intervals.
  
  
  RESULTS
  In total, 621 (36.3%) presented with sepsis, 1071 (62.5%) presented with severe sepsis, and 21 (1.2%) presented with septic shock. Thirty-day all-cause mortality for patients with sepsis, severe sepsis, and septic shock was 6.1, 18.8, and 38.1%, respectively. The adjusted HR among patients with sepsis of any severity within the time periods 31-180, 181-365, 366-720, and 721-1096 days was 7.1 (6.0-8.5), 2.8 (2.3-3.5), 2.1 (1.8-2.6), and 2.2 (1.7-2.9), respectively. Long-term mortality was unrelated to sepsis severity [721-1096 days: sepsis HR: 2.2 (1.5-3.2), severe sepsis HR: 2.1 (1.5-3.0)].
  
  
  CONCLUSIONS
  Patients admitted with community-acquired sepsis showed high intermediate-term mortality, increasing with sepsis severity. Long-term mortality was increased two-fold compared with sepsis-free individuals, but might be explained by unmeasured confounding. Further, long-term mortality was unrelated to sepsis severity.
authors.affiliation: Departments of aEmergency Medicine bClinical Chemistry and Pharmacology cRespiratory Medicine dClinical Microbiology eInfectious Diseases, Odense University Hospital fDepartment of Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Henriksen
authors.forename: Anton
authors.initials: A
authors.lastname: Pottegård
authors.forename: Christian B
authors.initials: CB
authors.lastname: Laursen
authors.forename: Thøger G
authors.initials: TG
authors.lastname: Jensen
authors.forename: Jesper
authors.initials: J
authors.lastname: Hallas
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
authors.forename: Annmarie T
authors.initials: AT
authors.lastname: Lassen
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D003718:Denmark; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D013997:Time Factors