Long-term cardiovascular outcomes and risk factors in adult sepsis survivors: a systematic review and meta-analysis.

Background: Sepsis may increase the risk of long-term cardiovascular outcomes. This study aims to investigate association between sepsis survivorship and cardiovascular outcomes and to identify risk factors.

Methods: We conducted a comprehensive systematic search of MEDLINE, EMBASE, the Cochrane Library, Wanfang, and CNKI from database inception through May 2025, without language restrictions. The primary outcome was a composite of myocardial infarction, stroke, congestive heart failure, or cardiovascular death. To evaluate the association between sepsis survivors and cardiovascular outcomes, we calculated cumulative incidence rates and hazard ratios (HRs) with corresponding 95% confidence intervals (95% CIs).

Results: Twenty-five observational studies comprising 7,525,271 participants were included. The pooled cumulative incidence of major cardiovascular events was 9.0% (95% CI: 6.1%-11.9%), myocardial infarction 2.4% (95% CI: 1.6%-3.1%), stroke 4.9% (95% CI: 3.8%-6.1%), and congestive heart failure 8.6% (95% CI: 4.6%-12.6%). Compared with non-sepsis controls, sepsis survivors had a significantly higher risk of major cardiovascular events (HR: 1.54; 95% CI: 1.32-1.79), myocardial infarction (HR: 1.41; 95% CI: 1.29-1.54), stroke (HR: 1.45; 95% CI: 1.32-1.60), and congestive heart failure (HR: 1.51; 95% CI: 1.46-1.56). Risk factors associated with increased cardiovascular events in sepsis survivors included age ≤ 45 years, male, hyperlipidemia, and multiple comorbidities.

Conclusion: Adult sepsis survivors may face significantly increased risks of long-term cardiovascular outcomes. Both common cardiovascular risk factors and sepsis-related pathophysiological changes contribute to this association.