Long term mortality in sepsis survivors: a population-based study during 15 years

Background Sepsis, defined as organ dysfunction due to a dysregulated host response to infection, remains a major global health burden. Sepsis short-term mortality have decreased due to advances in early recognition, standardized management and improved referral pathways. However, the long-term prognosis of sepsis survivors remains poorly understood, particularly in Europe, where studies are limited by small sample sizes or short follow-up. This study aimed to evaluate long-term mortality—defined as death within two years after hospital discharge—among sepsis survivors in Catalonia over a 15-year period, and to identify factors associated with increased long-term mortality. Methods A retrospective population-based study was conducted using the Catalan Minimum Basic Dataset of Acute-Care Hospitals. Sepsis cases were identified from 2005 to 2019 using ICD-9-CM and ICD-10-CM codes for infection and acute organ dysfunction. Patients who died during hospitalization, were transferred, or represented readmission episodes were excluded. Survivors were longitudinally followed for two years after discharge, with vital status obtained from the Central Registry of Insured Persons. Comorbidities were assessed using the Charlson index. Long-term mortality predictors were analyzed using logistic regression and Cox proportional hazards models. Results Among 296,554 hospital admissions for sepsis, 237,075 (79.9%) patients survived to discharge. Of these, 42% (99,571) died within two years. Long-term mortality increased with age (from 5.8% in patients < 15 years to 62% in those > 84 years; p < 0.0001) and with comorbidity (21%, 38%, 51% and 67% for Charlson index 0, 1–2, 3–4 and ≥ 5, respectively; p < 0.0001). Neoplasia (HR = 2.011), liver cirrhosis (HR = 1.562) and dementia (HR = 1.204) were the comorbidities most strongly associated with mortality. Longer hospital stays were also associated with increased mortality. A progressive decline in long-term mortality was observed during 2017–2019. Conclusions Long-term mortality among sepsis survivors remains alarmingly high, with over 40% dying within two years after discharge. These findings highlight the need to extend sepsis care beyond the acute episode, focusing on post-sepsis syndrome prevention, improved continuity of care, and structured follow-up—potentially including multidisciplinary and telemonitoring strategies—to reduce long-term morbidity and mortality. Identifying high-risk subgroups could optimize resource allocation and target interventions to those most likely to benefit.