Baseline morbidity and chronic medications as determinants of sepsis outcomes: focus on statins, corticosteroids, and NSAIDs in a population-based cohort of 59,578 patients.

Background: Sepsis is a leading cause of hospitalisation and mortality, particularly among older adults with multiple chronic conditions. While comorbidities are known to influence outcomes, the role of chronic medication use before sepsis onset remains underexplored. This study aimed to evaluate the impact of baseline health status and chronic treatments on sepsis-related mortality. Methods: A retrospective population-based cohort study was conducted using linked administrative data from the Catalan Health System. Adults hospitalised with sepsis across 65 public hospitals in Catalonia during 2018-2019 were included. Baseline morbidity was assessed using the Adjusted Morbidity Groups (GMA) tool. Chronic medication use was defined as having received six or more prescription fills of a drug class in the 8 months prior to admission. The primary outcome was in-hospital mortality. Results: Among 59,578 sepsis patients (mean age 75.4 years), the in-hospital mortality rate was 18.5%. Most infections were community-acquired (88%) and associated with renal (58.3%) or cardiovascular (25.7%) dysfunction. The cohort had high comorbidity rates, with a GMA of 37.3, high level of dependency on health services; and high baseline health expenditure. Chronic use of statins, corticosteroids, and non-steroidal anti-inflammatory drugs (NSAIDs), was observed in 28.5%, 5.6%, and 2.3% of patients respectively. Patients with high or very high GMA scores had the highest mortality rates. In multivariable analysis, chronic statin use was associated with lower odds of death (OR 0.782; 95% CI: 0.740-0.825), while corticosteroid (OR 1.191, 95% CI 1.085-1.306) and NSAID use (OR 1.415, 95% CI 1.226-1.632) were linked to increased mortality. Other risk factors included advanced age, active cancer, cirrhosis, and bloodstream infection. Conclusion: In this large population-based study, baseline comorbidities and chronic treatments significantly influenced sepsis outcomes. Statin use was associated with lower in-hospital mortality, whereas corticosteroids and NSAIDs were linked to worse prognosis. The GMA score proved useful in stratifying patient risk and may help to inform clinical decision-making and resource planning. ClinicalTrials.gov: NCT06354452.