Background
Methods
Approach
Information sources
Eligibility criteria for full text review
Study selection for evidence synthesis
Data collection process and items
Outcome definitions
Description of bias assessment
Description of confounding assessment
Statistics
Results
Study selection
Methodological assessment summary (N=59 studies) | %* |
---|---|
1. Exposure definition (sepsis) | |
49 % | |
14 % | |
20 % | |
15 % | |
5 % | |
2. Ascertainment of exposure | |
i) Claims/ICD codes data | 13 % |
10 % | |
iii) Non-interventional study cohorts | 75 % |
3. Selection of the control cohort | |
i) Drawn from ICU patients without sepsis | |
a. Matched [35] | 2 % |
12 % | |
ii) Drawn from hospitalized infected patients (not ICU) | |
a. Matched | |
3 % | |
iii) Drawn from hospitalized non-infected patients (not ICU) | |
a. Matched [36] | 2 % |
10 % | |
iv) Population controls | |
10 % | |
3 % | |
v) No control cohorts/no controls for mortality comparison | 73 % |
4. Comparability of cohorts on the basis of design or analysis | |
i) Regression models to adjust for confounders | |
a. Regression models in studies reporting control population | |
16 % | |
- Cumulative mortality | |
5 % | |
5 % | |
b. Regression models using in studies with no controls | |
- Post-acute mortality | 22 % |
- Cumulative mortality | 20 % |
- No mortality model | 31 % |
9 % | |
5. Assessment of post-acute mortality | |
i) Record linkage with national or regional databases or outcome assessed by contact with patient or relatives | 90 % |
ii) No description | 10 % |
6. Adequacy of follow up | |
i) Complete follow up, all participants accounted for | 22 % |
ii) Loss to follow up unlikely to introduce bias (<20 % loss, or >20 % but those lost described and unlikely to be different from those followed) | 61 % |
iii) Follow up <80 % and no description of those lost | 3 % |
iv) No statement | 14 % |
7. Report both acute and post-acute mortality (or that information can be determined from the reported data) | |
i) At one year | 72.9 % |
8.5 % | |
10.2 % |
Post-acute mortality
Bias assessment
Confounding assessment
Studies reporting controls
Studies reporting general population controls
Studies reporting hospital controls
Dose-response effect of sepsis on post-acute mortality
Discussion
Conclusions
Key messages
-
Post-acute mortality in sepsis survivors is common; however, causality and the magnitude of this relationship is uncertain
-
Acute mortality from sepsis has improved with time. Most studies in this systematic review report patient cohorts recruited before the year 2005 and report additional one-year risk of death following sepsis. Only a minority of included studies report control cohorts and explicitly assess sepsis-specific additional risk
-
Our systematic review thus highlights the need for well-conducted studies using more recent datasets to identify the independent (and modifiable) predictors of post-acute mortality in sepsis survivors