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Late mortality after sepsis: propensity matched cohort study

BMJ 2016; 353 doi: (Published 17 May 2016) Cite this as: BMJ 2016;353:i2375
  1. Hallie C Prescott, assistant professor1 2 3 4,
  2. John J Osterholzer, assistant professor1 4,
  3. Kenneth M Langa, professor1 2 3 5,
  4. Derek C Angus, professor and chair6,
  5. Theodore J Iwashyna, associate professor1 2 3 4 5 7
  1. 1Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
  2. 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
  3. 3VA Center for Clinical Management Research, Health Services Research and DevelopmentCenter of Innovation, Ann Arbor, MI, USA
  4. 4Pulmonary Section, Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
  5. 5Institute for Social Research, Ann Arbor, MI, USA
  6. 6Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  7. 7Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  1. Correspondence to: H C Prescott, University of Michigan, 2800 Plymouth Road, North Campus Research Center, Bldg. 16, 341E, Ann Arbor, MI 48109-2800, USA hprescot{at}
  • Accepted 20 April 2016


Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

Deign Observational cohort study.

Setting US Health and Retirement Study.

Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals.

Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.


  • We thank the participants in the Health and Retirement Study whose data were included in this study.

  • Contributors: HCP designed the study, analyzed the data, interpreted the data, and drafted the manuscript. JJO, DCA, and TJI interpreted the data and revised the manuscript critically for intellectual content. KML acquired the data, interpreted the data, and revised the manuscript critically for intellectual content. HCP had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding: This work was supported by grants T32 HL007749 (HCP), L30 GM116118 (HCP), and K08 GM115859 (HCP) from the National Institutes of Health and IIR 11-109 (TJI) from the US Department of Veterans Affairs Health Services Research and Development Service. The Health and Retirement Study is sponsored by the National Institute on Aging (U01 AG009740) and performed at the Institute for Social Research, University of Michigan. The funders were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: University of Michigan IRB approved this study. Informed consent was obtained on enrollment into the Health and Retirement Study and again for Medicare linkage

  • Data sharing: Important components of the statistical code are included in appendix 3. Additional code can be obtained from the corresponding author on request. HRS survey data are available through the HRS website.

  • Transparency: The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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