Long-term survival in patients discharged alive from hospital following an intensive care unit admission with sepsis or septic shock in Australia and New Zealand: an observational cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Data on long-term survival after intensive care unit (ICU) admission for sepsis and septic shock are limited. This study aimed to evaluate survival over five years among critically ill sepsis or septic shock patients discharged alive from hospital. Methods: This retrospective cohort study of adults who survived to hospital discharge after non-elective ICU admission (2018-2024) used Australian and New Zealand Intensive Care Society Adult Patient Database. Sepsis, septic shock, or non-sepsis patients were classified using diagnostic codes and physiological/laboratory criteria during first 24-h of ICU admission. Mixed-effects Cox models with time-varying covariate effects were used, adjusting for demographics, comorbidities, frailty, illness severity, and ICU interventions. Findings: Of 557,538 hospital survivors, 7.3% had sepsis without shock, 11.5% septic shock, and 81.2% non-sepsis conditions. At five-years, unadjusted survival was lowest for septic shock (68.0%, 95% confidence interval/CI = 67.6-68.4%), sepsis without shock (74.2%, 73.7-74.6%), and non-sepsis (78.2%, 78.1-78.3%). After adjustment, hazards ratio/HR for sepsis without shock remained at or below the null relative to non-sepsis; 0-1 year: HR = 0.95, 0.92-0.98; 1-3 years: 0.96, 0.93-1.00; 3-5 years: 1.03, 0.97-1.08, while septic shock showed persistent independent excess mortality; 0-1 year: HR = 1.05,1.03-1.08; 1-3 years: 1.03, 1.00-1.06; and 3-5 years:1.09,1.05-1.14. Major predictors of mortality included age, frailty, comorbidities, and organ support. Interpretation: Septic shock was associated with persistent independent excess mortality over five years after hospital discharge, whereas in sepsis without shock, this was largely explained by pre-existing comorbidity and frailty. Funding: Medical Research Future Fund.
Authors: Win Wah, Alexis Paul Poole, Lewis Campbell, Jeremy Cohen, Jamie Cooper, Adam Deane, Anthony Delaney, Glenn Eastwood, Simon Finfer, Craig French, Kimberley Haines, Naomi Hammond, Alisa Higgins, Carol Hodgson, Daryl Jones, Edward Litton, Zoe McQuilten, Ary Serpa Neto, David Pilcher, Sandra Peake, Manoj Saxena, Kiran Shekar, Kelly Thompson, Steven Webb, Paul J. Young, Andrew A. Udy
Institutions: Monash University, Royal Darwin Hospital, The University of Queensland, The Royal Melbourne Hospital, The University of Melbourne, The University of Sydney, The George Institute for Global Health, Austin Hospital, UNSW Sydney, Western Health, Austin Health, Fiona Stanley Hospital, Monash Health, The Alfred Hospital, Australian and New Zealand Intensive Care Society, Queen Elizabeth Hospital, The University of Adelaide, St George Hospital, Prince Charles Hospital, Wellington Hospital, Wakefield Hospital, Medical Research Institute of New Zealand
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,250
OpenAlex ID: W7166152525