Abstract
Background: Risk of recurrence after surviving severe sepsis remains poorly understood.
Methods: Using Taiwan's National Health Insurance Research Database, we analyzed 10,818 adults who survived first-episode severe sepsis without recurrence for at least 3 months in 2000 (SS group, mean age 62.7 years; men 54.7%) and a group of age/sex-matched (1:1) population controls who had no prior history of severe sepsis. Primary outcome was severe sepsis that occurred after January 1, 2001 (the study entry). All subjects were followed from the study entry to the occurrence of end-point, death, or December 31, 2008, whichever date came first. Relative risk of recurrence was assessed using competing risk regression model.
Results: During the study period, severe sepsis and death occurred in 35.0% and 26.5% of SS group and in 4.3% and 18.6% of controls, respectively. The incidence of severe sepsis was much higher in SS group than in controls (75.18 vs. 6.13 per 1,000 person-years), with a covariate-adjusted subhazard ratio (sub-HR) of 8.89 (95% confidence interval 8.04-9.83). In stratified analysis by levels of socio-demographics and comorbid burden, the sub-HRs ranged from 7.74 in rural area residents to 23.17 in young adults (<45 years). In subgroup analysis by first-episode infection sites in SS group, the sub-HRs ranged from 4.82 in intra-abdominal infection to 9.99 in urinary tract infection.
Conclusions: Risk of recurrence after surviving severe sepsis is substantial regardless of patient characteristics or infection sites. Further research is needed to find underlying mechanisms for the high risk of recurrence in these patients.
- Copyright ©ERS 2015
