Prognostic factors of sepsis: a systematic review and meta-analysis

Abstract

Objective: This study aimed to systematically identify and evaluate prognostic risk factors for 30-day mortality in patients with sepsis through a meta-analysis. Methods: Chinese and English databases were comprehensively searched from the start of the study to January 2025. Observational studies reporting multi-variable adjusted risk ratios (HRS) for prognostic factors of sepsis in adults were included. Data extraction and quality assessment using the Newcastle-Ottawa Scale were performed independently by two reviewers. Meta-analysis was performed using RevMan 5.4.1, and effect estimates were summarized using fixed or random effects models based on heterogeneity. Results: Twenty studies involving 69 potential factors were included. A meta-analysis was performed on 15 factors. Increase in age (HR: 1.01), acute kidney injury (HR: 1.48), cancer (HR: 1.21), liver disease (HR: 1.58), septic shock (HR: 2.22), APACHE II (HR: 1.06), SOFA (HR: 1.19), SAPS II score (HR: 1.02), lactate (HR: 1.07) and red blood cell distribution width (HR: 1.07) were significant risk factors. Diabetes (HR: 0.80) and urinary tract infection (HR: 0.47) were protective factors. A high degree of heterogeneity was observed in some factors. Conclusions: Multiple factors have a significant impact on the mortality of sepsis. Early identification of these risk factors can guide clinical intervention strategies and improve patient outcomes.