Predictors of Mortality in Sepsis Across Medical, Surgical, and Obstetric Populations: A Systematic Review

Abstract

Sepsis is a heterogeneous syndrome in which mortality reflects the interaction of host vulnerability, infection characteristics, the magnitude and trajectory of organ dysfunction, physiologic reserve, and the timeliness and adequacy of treatment. Contemporary definitions emphasize life-threatening organ dysfunction caused by a dysregulated host response to infection, while clinical practice increasingly requires risk stratification that can identify patients likely to deteriorate before irreversible organ injury develops [1]. To synthesize evidence on clinical, laboratory, physiologic, microbiologic, treatment-related, and population-specific predictors of mortality in adult sepsis, with explicit comparison across medical, surgical, and obstetric populations [2].A structured systematic-review framework was developed using the organization of the previously supplied transfusion-threshold review as a methodological model, including PRISMA-oriented reporting, predefined eligibility domains, outcome definitions, risk-of-bias considerations, subgroup synthesis, and evidence grading. The present manuscript incorporates targeted contemporary evidence from PubMed-indexed systematic reviews, meta-analyses, guidelines, landmark cohorts, and prediction-model studies through August 2026; because a full reproducible multi-database export and dual-reviewer screening log were not supplied, numerical PRISMA counts are deliberately not fabricated [3].The evidence consistently identifies increasing age, higher baseline illness burden, elevated lactate, persistent hyperlactatemia or poor lactate clearance, higher SOFA or other severity scores, vasopressor dependence, mechanical ventilation, acute kidney injury, multiple organ dysfunction, hypoalbuminemia, and selected infection sources as clinically important markers of mortality risk. In prognostic-model literature, age, lactate, albumin, SOFA score, and vasopressor use are among the most frequently incorporated predictors, although methodological quality and external validation remain inconsistent [4]. Mortality in sepsis is best understood as a dynamic phenotype rather than a consequence of a single abnormality. The strongest prognostic signal arises when static vulnerability factors converge with early physiologic deterioration and failure to recover after treatment. Medical, surgical, and obstetric populations share core predictors but differ in baseline physiology, source-control requirements, disease trajectories, and thresholds for escalation, making context-specific risk assessment essential [5].