Association of Sepsis Survivor Subtypes With Long-Term Mortality and Disability After Discharge: A Retrospective Cohort Study

Objectives: Determine if previously described sepsis survivor subtypes can be applied outside of their derivation cohort using a parsimonious algorithm. Test the association between subtype and the primary outcome of 3-month mortality, and secondary outcomes of readmission, physical function, and health-related quality of life through 1 year of follow-up. Design: Retrospective cohort study. Setting: Participants enrolled in the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial, a multisite trial in the United States that enrolled patients with sepsis-induced hypotension. Patients: All participants who were alive on day 28 after enrollment and had nonmissing data for outcome and subtype-defining variables (Charlson Comorbidity Index, length of stay, discharge destination). Participants were retrospectively assigned at time of discharge to one of five previously derived survivor subtypes: low risk, healthy with severe disease, multimorbidity, low functional status, and unhealthy baseline with severe disease. Interventions: None. Measurements and Main Results: Of 1563 participants, 1368 were eligible and assigned a subtype. Three-month mortality was 13.1% and varied significantly between subtypes (5.1–45.5%; p < 0.001). In age-adjusted logistic regression, odds ratios for 3-month mortality were 11.1 in the low functional status and 9.7 in the unhealthy baseline with severe illness subtypes, compared with the low-risk subtype ( p < 0.001). Participant subtype was a significant predictor of 6- and 12-month EuroQol 5D five level score and limitations in activities of daily living, but not readmission. Conclusions: Sepsis survivor subtypes that are readily identifiable at hospital discharge are significantly associated with mortality at 3 months, and patient-important outcomes through 12 months. Using subtypes to predict a patient’s risk of adverse outcomes could aid the discharge planning and recovery process.