Three out of four sepsis survivors are affected by new memory disorders or mental or physical illness. Even in the under-40 group, more than half of sepsis survivors suffer from it. Those are two findings of an anonymized analysis of health insurance data now published in the journal JAMA Network Open. The team of authors from the University Hospital Jena, Charité – Universitätsmedizin Berlin and the Scientific Institute of the AOK examines the frequency and costs of the health consequences of sepsis.
Medical science defines sepsis as a dangerous organ dysfunction caused by an excessive immune response to an infection. This life-threatening condition occurs when the body’s response to an infection damages its own tissues so that organs such as the kidney or liver no longer function. Worldwide, sepsis is the leading cause of infection-related death. In Germany, 320,000 cases are hospitalized each year, and the in-hospital mortality rate is about 25%, which is alarmingly high. The majority of those treated with severe COVID-19 also present with sepsis, according to recent studies.
Research results of the Center for Sepsis and Sepsis Consequences (CSCC) at the University Hospital Jena (UKJ) have not only contributed significantly to the networking of patient-oriented basic research with clinical research in the field of sepsis, the center has also investigated long-term consequences and rehabilitation after the severe disease. An interdisciplinary post-covid center is currently being established here. A cooperation between the UKJ and the Charité, funded by the Federal Joint Committee with resources from the Innovation Fund, has now analyzed the sequelae, risk factors, care and costs of sepsis together with the Scientific Institute of the AOK.
For the analysis, the study team was able to draw on the anonymized health data of more than 23 million people insured by the AOK from 2009 to 2017, which can well represent the German population as a whole. Among them, the team identified 159,684 insured individuals aged 15 and older who were hospitalized for sepsis in a regular or intensive care unit in 2013 or 2014. For these, pre-existing conditions were recorded, as well as diagnoses that were new in the three years following sepsis and the resulting treatment and care needs. “In the process, we looked for new physical, psychological and cognitive impairments that are known to occur as a result of sepsis – such as cardiovascular diseases, cognitive or motor disorders, fatigue syndrome or depression,” says project leader Dr. Carolin Fleischmann-Struzek.
In the first year after discharge alone, three-quarters of sepsis survivors had a new diagnosis, and more than 30% died within the first year. Even in the group under 40 years of age, more than 56% developed secondary diseases in the first year after the disease. Prof. Dr. Christiane Hartog, a health services researcher at the Clinic for Anesthesiology with a focus on Operative Intensive Care Medicine at Charité and the study’s final author, emphasizes: “Psychological, cognitive and physical consequences affect the majority of survivors and even frequently occur together, which is a particular burden for those affected. Surprisingly, it makes little difference whether the sepsis was less severe or had to be treated in the intensive care unit. Especially with regard to the infection sequelae syndrome after covid-19, this is of great relevance.”
The study team also analyzed the costs incurred by survivors for inpatient and outpatient treatment, rehabilitation, remedies and medications. It puts the cost of treatment per case in the first three years after the disease at 29,000 euros. This does not include emergency and transport costs, aids, care costs and indirect costs such as loss of work. More than 30% of sepsis survivors required nursing home care in the year after hospital discharge, and more than 13% required new nursing home care after a severe course. The team of authors also states in their study that there are hardly any adapted follow-up measures. Only 5% of sepsis survivors were discharged to a rehabilitation facility. “Sepsis has massive and long-lasting consequences – both for survivors and their relatives, and for the healthcare system. That is why specific follow-up concepts for sepsis are needed,” emphasizes Carolin Fleischmann-Struzek.
Original publication:
Fleischmann-Struzek C, et al. Epidemiology and Costs of Postsepsis Morbidity, Nursing Care Dependency, and Mortality in Germany, 2013 to 2017. JAMA Netw Open. 2021;4(11):e2134290. doi:10.1001/jamanetworkopen.2021.34290 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2786030
