MAGNITUDE AND DURATION OF THE EFFECT OF SEPSIS ON SURVIVAL

Objective.-To determine the magnitude and duration of the effects of s epsis on survival. Design.-Cohort study. Setting.-The 10 Department of Veterans Affairs Medical Centers of the Systemic Sepsis Cooperative S tudies Group, which from 1983 to 1986 conducted the Department of Vete rans Affairs Cooperative Study of Corticosteroids in Systemic Sepsis. Patients.-The septic population consisted of 1505 patients with evalua ble data from the screening log of the Cooperative Study of Corticoste roids in Systemic Sepsis, All 91 830 nonpsychiatric, noninfected patie nts discharged from the participating medical centers between October 1, 1984, and September 30, 1985, were included in the control populati on. Main Outcome Measure.-Death through 8 years after the index hospit alization. Results.-On the basis of a proportional hazards model const ructed from the demographic and illness characteristics of the control population, the septic population was at significant risk of dying of nonseptic causes (26% predicted 1-year mortality), In the septic popu lation, the daily risk of dying exceeded predictions from this model f or 5 years, and the hazard rate rose with increasing severity of the s eptic episode throughout the first year (P<.05). Among 30-day survivor s, sepsis reduced the remaining mean life span from a predicted 8.03 y ears to 4.08 years. Conclusions.-Sepsis not only causes deaths acutely , but also increases the risk of death for up to 5 years after the sep tic episode even after comorbidities are accounted for. The risk of la te death during the first year is associated with the severity of the septic episode.