Long-term mortality and medical care charges in patients with severe sepsis

Objective To estimate long-term mortality and medical care charges among patients with severe sepsis. Design Retrospective cohort study. Setting Large, integrated, geographically diverse, U.S. health-insurance claims database covering three million lives annually. Patients All persons with bacterial or fungal infections and acute organ dysfunction (severe sepsis) who were hospitalized between January 1, 1991, and August 31, 2000. Interventions None. Measurements and main results All patients were followed from the date of hospitalization with severe sepsis (index admission) to August 31, 2000, disenrollment from the health plan, or death, whichever occurred first. Measures of interest included mortality and medical care charges and were estimated for the index admission, the 90- and 180-day periods following the index admission, and annually thereafter (up to 5 yrs), using techniques of survival analysis. A total of 16,019 patients were identified who met study entrance criteria. Most patients (81.2%) were >/=65 yrs of age; 53.4% were men. Mortality was 21.2% for the index admission, 51.4% at 1 yr, and 74.2% at 5 yrs. Mean cumulative total medical care charges were 44,600 US dollars for the index admission, 78,500 US dollars at 1 yr, and 118,800 US dollars at 5 yrs. Hospitalization accounted for the largest component of total medical care charges. Conclusions Mortality and economic costs are high in patients with severe sepsis, during the period of acute illness as well as subsequently.