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Association between sepsis survivorship and long-term cardiovascular outcomes in adults: a systematic review and meta-analysis

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Abstract

Purpose

We aimed to determine the association between sepsis and long-term cardiovascular events.

Methods

We conducted a systematic review of observational studies evaluating post-sepsis cardiovascular outcomes in adult sepsis survivors. MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception until April 21st, 2021. Two reviewers independently extracted individual study data and evaluated risk of bias. Random-effects models estimated the pooled crude cumulative incidence and adjusted hazard ratios (aHRs) of cardiovascular events compared to either non-septic hospital survivors or population controls. Primary outcomes included myocardial infarction, stroke, and congestive heart failure; outcomes were analysed at maximum reported follow-up (from 30 days to beyond 5 years post-discharge).

Results

Of 12,649 screened citations, 27 studies (25 cohort studies, 2 case-crossover studies) were included with a median of 4,289 (IQR 502–68,125) sepsis survivors and 18,399 (IQR 4,028–83,506) controls per study. The pooled cumulative incidence of myocardial infarction, stroke, and heart failure in sepsis survivors ranged from 3 to 9% at longest reported follow-up. Sepsis was associated with a higher long-term risk of myocardial infarction (aHR 1.77 [95% CI 1.26 to 2.48]; low certainty), stroke (aHR 1.67 [95% CI 1.37 to 2.05]; low certainty), and congestive heart failure (aHR 1.65 [95% CI 1.46 to 1.86]; very low certainty) compared to non-sepsis controls.

Conclusions

Surviving sepsis may be associated with a long-term, excess hazard of late cardiovascular events which may persist for at least 5 years following hospital discharge.

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Data availability

Upon request, from corresponding author.

Code availability

Statistical code included in the supplement.

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Author notes

  1. Leah B. Kosyakovsky and Federico Angriman contributed equally to this manuscript.

Authors and Affiliations

  1. Peter Munk Cardiac Centre, University Health Network, RFE3-410, 190 Elizabeth St, Toronto, Canada

    Leah B. Kosyakovsky, Lucas C. Godoy, Augustin Toma & Patrick R. Lawler

  2. Department of Medicine, University of Toronto, Toronto, Canada

    Leah B. Kosyakovsky, Augustin Toma & Michael E. Farkouh

  3. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada

    Federico Angriman, Neill K. Adhikari, John C. Marshall, Bruno L. Ferreyro, Margaret Herridge, Damon C. Scales, Michael E. Detsky & Patrick R. Lawler

  4. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Federico Angriman, Neill K. Adhikari, Lucas C. Godoy, Dennis T. Ko & Damon C. Scales

  5. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

    Federico Angriman, Neill K. Adhikari & Damon C. Scales

  6. Department of Medicine, McGill University, Montreal, Canada

    Emma Katz

  7. ICES, Toronto, Canada

    Lucas C. Godoy, Douglas S. Lee & Dennis T. Ko

  8. Faculdade de Medicina FMUSP, Instituto do Coracao (InCor), Universidade de Sao Paulo, São Paulo, Brazil

    Lucas C. Godoy

  9. Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada

    Bruno L. Ferreyro & Michael E. Detsky

  10. Ted Rogers Centre for Heart Research, Toronto, Canada

    Douglas S. Lee & Patrick R. Lawler

  11. Metabolism and Lipids Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, USA

    Robert S. Rosenson

  12. Institute for Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland

    Naveed Sattar

  13. Keenan Research Centre for Biomedical Science, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Subodh Verma

  14. Library and Information Services, University Health Network, Toronto, Canada

    Marina Englesakis

  15. Department of Cardiology, Trillium Health Partners, Mississauga, Canada

    Barry Burstein & Michael E. Farkouh

  16. Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Canada

    Dennis T. Ko

  17. Department of Medicine, Hôpital Pierre-Boucher, Longueuil, Canada

    Lior Bibas

  18. Department of Surgical Intensive Care, Montreal Heart Institute, Montreal, Canada

    Lior Bibas

Authors
  1. Leah B. Kosyakovsky
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  2. Federico Angriman
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Contributions

PRL accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. All authors meet ICMJE recommendations for authorship and have made substantial contributions to the concept or design of the work (LK, FA, EK, NA, LG, JM, BLF, DL, RS, NS, SV, AT, ME, BB, MF, MH, DK, DS, MD, LB, PL), acquisition or analysis of the data (LK, FA, EK, NA, LB, PL); interpretation of the data (all authors); drafted the work or revised it critically for important intellectual content (all authors); gave final approval of the version to be published (all authors).

Corresponding author

Correspondence to Patrick R. Lawler.

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Conflicts of interest

PRL has received unrelated research funding from the Canadian Institutes of Health Research, the National Institutes of Health, the Peter Munk Cardiac Centre, the LifeArc Foundation, the Thistledown Foundation, and the Province of Ontario. He has received unrelated consulting honoraria from Novartis, Corrona, and Brigham and Women’s Hospital, as well as unrelated royalties from McGraw-Hill Publishing. FA is supported by a Vanier Canada Scholarship from the Canadian Institutes of Health Research. DCS holds operating grants from the Canadian Institutes of Health Research. MEF receives grant support from Amgen, Novartis, and Novo Nordisk. DSL is the Ted Rogers Chair in heart function outcomes at the University Health Network. DTK is supported by the Jack Tu Chair in Cardiovascular Outcomes Research at Sunnybrook Health Sciences Centre. No other relationships or activities that could appear to have influenced the submitted work.

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Kosyakovsky, L.B., Angriman, F., Katz, E. et al. Association between sepsis survivorship and long-term cardiovascular outcomes in adults: a systematic review and meta-analysis. Intensive Care Med 47, 931–942 (2021). https://doi.org/10.1007/s00134-021-06479-y

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  • DOI: https://doi.org/10.1007/s00134-021-06479-y

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