Sepsis is a frequent reason for ICU admission and a leading cause of death. Its incidence has been increasing over the past decades. While hospital mortality is decreasing, it is recognized that the sequelae of sepsis extend well beyond hospitalization and are associated with a high mortality rate that persists years after hospitalization. The aim of this study was to disentangle the relative contribution of sepsis (infection with multi-organ failure), of infection and of inflammation, as reasons for ICU admission to long-term survival. This was done as infection and inflammation are both cardinal features of sepsis. We assessed the 3-year mortality of ICU patients admitted with sepsis, with individually matched ICU patients with an infection but not sepsis, and with an inflammatory illness not caused by infection, discharged alive from hospital. A multicenter cohort study of adult ICU survivors admitted between January 1st 2007 and January 1st 2019, with sepsis, an infection or an inflammatory illness. Patients were classified within the first 24 h of ICU admission according to APACHE IV admission diagnoses. Dutch ICUs (n = 78) prospectively recorded demographic and clinical data of all admissions in the NICE registry. These data were linked to a health care insurance claims database to obtain 3-year mortality data. To better understand and distinct the sepsis cohort from the non-sepsis infection and inflammatory condition cohorts, we performed several sensitivity analyses with varying definitions of the infection and inflammatory illness cohort. Three-year mortality after discharge was 32.7% in the sepsis (N = 10,000), 33.6% in the infectious (N = 10,000), and 23.8% in the inflammatory illness cohort (N = 9997). Compared with sepsis patients, the adjusted HR for death within 3 years after hospital discharge was 1.00 (95% CI 0.95–1.05) for patients with an infection and 0.88 (95% CI 0.83–0.94) for patients with an inflammatory illness. Both sepsis and non-sepsis infection patients had a significantly increased hazard rate of death in the 3 years after hospital discharge compared with patients with an inflammatory illness. Among sepsis and infection patients, one third died in the next 3 years, approximately 10% more than patients with an inflammatory illness. The fact that we did not find a difference between patients with sepsis or an infection suggests that the necessity for an ICU admission with an infection increases the risk of long-term mortality. This result emphasizes the need for greater attention to the post-ICU management of sepsis, infection, and severe inflammatory illness survivors.

中文翻译：

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患有败血症、感染或炎症性疾病的 ICU 幸存者的三年死亡率：2007 年至 2019 年荷兰 ICU 患者的单独匹配队列研究


脓毒症是入住 ICU 的常见原因，也是导致死亡的主要原因。在过去的几十年里，它的发病率一直在增加。虽然住院死亡率正在下降，但人们认识到脓毒症的后遗症远远超出了住院治疗的范围，并且与住院后持续数年的高死亡率有关。本研究的目的是理清脓毒症 （感染伴多器官衰竭）、感染和炎症作为入住 ICU 对长期生存原因的相对贡献。这样做是因为感染和炎症都是脓毒症的主要特征。我们评估了因脓毒症收治的 ICU 患者的 3 年死亡率，其中个体匹配的 ICU 患者有感染但未患脓毒症，患有非感染引起的炎症性疾病，活着出院。一项针对 2007 年 1 月 1 日至 2019 年 1 月 1 日期间因败血症、感染或炎症性疾病入院的成年 ICU 幸存者的多中心队列研究。根据 APACHE IV 入院诊断，在入住 ICU 后的前 24 小时内对患者进行分类。荷兰 ICU （n = 78） 前瞻性地记录了 NICE 登记处所有入院的人口统计学和临床数据。这些数据与医疗保险索赔数据库相关联，以获得 3 年死亡率数据。为了更好地了解和区分脓毒症队列与非脓毒症感染和炎症队列，我们进行了几项敏感性分析，对感染和炎症性疾病队列的定义各不相同。脓毒症出院后三年死亡率为 32.7% （N = 10,000），感染性 （N = 10,000） 为 33.6%，炎症性疾病队列 （N = 9997） 为 23.8%。 与脓毒症患者相比，感染患者出院后 3 年内死亡的校正 HR 为 1.00 （95% CI 0.95-1.05），炎症性疾病患者为 0.88 （95% CI 0.83-0.94）。与炎症性疾病患者相比，脓毒症和非脓毒症感染患者在出院后 3 年内的死亡风险率均显著增加。在脓毒症和感染患者中，三分之一的患者在未来 3 年内死亡，比炎症性疾病患者多出约 10%。我们没有发现脓毒症患者或感染患者之间存在差异的事实表明，感染患者入住 ICU 的必要性会增加长期死亡的风险。这一结果强调了需要更加关注脓毒症、感染和严重炎症性疾病幸存者的 ICU 后管理。