Prevalence and Factors Associated with Cognitive Impairment Among Sepsis Survivors: A Systematic Review and Meta-Analysis.

Abstract

Background: Sepsis survivors frequently experience cognitive impairment, which negatively affects long-term quality of life and functional recovery. However, the prevalence and associated factors remain insufficiently characterized.

Objective: This study aimed to evaluate the prevalence of cognitive impairment among sepsis survivors across different follow-up periods and identify associated factors using systematic review and meta-analysis.

Methods: PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, Wanfang Data, and VIP Database were searched from inception to March 19, 2026. Cohort and cross-sectional studies were included. Random-effects models were used to estimate pooled prevalence and odds ratios, and the certainty of evidence was evaluated using the GRADE approach.

Results: Eighteen studies involving 218,152 sepsis survivors were included. Cognitive impairment remains common among sepsis survivors, with prevalence estimates varying across follow-up time points. Older age, prolonged delirium duration, hyperglycemia, and hypoxemia were positively associated with cognitive impairment (ORs ranging from 1.12 to 2.84). The certainty of evidence ranged from very low to low.

Conclusions: The pooled prevalence of cognitive impairment among sepsis survivors differed across follow-up time points. However, because estimates at different time points were largely based on different studies and populations, these findings should be interpreted as study-level time-stratified differences rather than evidence of within-individual cognitive recovery or decline. Older age, prolonged delirium duration, hyperglycemia, and hypoxemia were associated with cognitive impairment among sepsis survivors. Given the low to very low certainty of the available evidence, the observed associations should be interpreted cautiously. Further well-designed prospective studies are needed to confirm these findings.