Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection and remains a leading cause of morbidity and mortality worldwide [1]. Despite advancements in critical care medicine, the burden of sepsis continues to increase due to aging populations, rising antimicrobial resistance, and increasing prevalence of chronic illnesses [2].

The Sequential Organ Failure Assessment (SOFA) score has become an important clinical tool for assessing the severity of organ dysfunction in septic patients [3]. Serial SOFA score measurement can provide insight into disease progression and therapeutic response [4]. An increasing SOFA score during hospitalization is strongly associated with poor clinical outcomes [5].

Comorbid illnesses may alter immune response, inflammatory pathways, and physiological reserve, thereby affecting sepsis progression [6]. Diabetes mellitus is associated with impaired neutrophil function and endothelial dysfunction [7]. Chronic kidney disease predisposes patients to immune dysregulation and persistent inflammation [8]. Chronic liver disease contributes to altered cytokine regulation and coagulation abnormalities [9].

Hypertension and cardiovascular disease may worsen microvascular dysfunction during sepsis [10]. Similarly, chronic pulmonary diseases may compromise oxygen delivery and worsen respiratory failure [11]. Previous studies have suggested that pre-existing diseases increase mortality risk in sepsis [12,13].

However, limited data are available regarding the direct relationship between individual comorbidities and serial SOFA score changes [14]. Understanding this association may help clinicians identify patients at greater risk of deterioration [15].

This study was conducted to evaluate the correlation between specific comorbidities and sepsis progression using SOFA score trends in a tertiary care setting [16].

Study Design Prospective observational study conducted over 12 months. Study Setting Intensive care units and medical wards of a tertiary care teaching hospital. Study Population Inclusion criteria • Age ≥18 years • Diagnosis of sepsis according to Sepsis-3 criteria • Admission within 24 hours of symptom onset Exclusion criteria • Pregnancy • Malignancy under chemotherapy • Incomplete follow-up Sample Size A total of 240 patients were included. Comorbidities Recorded • Diabetes mellitus • Hypertension • Chronic kidney disease • Chronic liver disease • COPD SOFA Assessment SOFA score calculated: • Day 1 • Day 3 • Day 7 Statistical Analysis Software: SPSS version 26 Tests used: • Chi-square test • Repeated measures ANOVA • Multivariate linear regression Significance: p < 0.05

Patient Characteristics

Among 240 patients, diabetes mellitus was the most common comorbidity (35.8%), followed by hypertension (30.4%) and CKD (18.7%). Baseline characteristics are summarized in Table 1.

Table 1. Baseline characteristics of study participants

SOFA Score Trends

Mean SOFA scores progressively increased in patients with CKD and CLD. Detailed score progression is shown in Table 2.

Table 2. Mean SOFA score trends by comorbidity

(*Statistically significant)

Independent Predictors of SOFA Worsening

Multivariate regression identified CKD and diabetes as independent predictors of worsening SOFA progression (Table 3).

Table 3. Multivariate regression analysis

Mortality According to Comorbidity

Mortality was highest among patients with CKD (48.9%) followed by CLD (42.8%). The comparison is shown in Figure 1.

Figure 1. Mortality percentage according to major comorbidities

Summary of Findings

Patients with:

• CKD had the highest SOFA increase (p < 0.001)
• CLD showed marked organ dysfunction progression (p < 0.001)
• Diabetes was associated with moderate worsening (p = 0.018)

These findings indicate a strong relationship between chronic disease burden and sepsis progression.

The present study demonstrated that specific comorbid conditions significantly influence sepsis progression measured by SOFA score trends. Patients with CKD showed the greatest deterioration, suggesting impaired physiological reserve [17]. Chronic kidney disease contributes to immune dysfunction, endothelial injury, and chronic inflammation, all of which may intensify organ failure during sepsis [18]. Similar findings have been reported by previous investigators who observed increased mortality in septic patients with renal impairment [19]. Diabetes mellitus was also independently associated with worsening SOFA scores. Hyperglycemia can impair neutrophil function and increase oxidative stress [20]. Prior studies have reported poor outcomes in septic diabetic patients due to altered host defense mechanisms [21]. Patients with chronic liver disease demonstrated rapid organ dysfunction progression. Hepatic dysfunction alters complement activation and inflammatory regulation [22]. Similar associations have been described in earlier critical care studies [23]. The SOFA score remains an effective tool for monitoring progression and may help identify high-risk patients with chronic diseases [24]. Early intervention in these patients may reduce deterioration and improve survival [25].

Specific comorbidities, particularly chronic kidney disease and diabetes mellitus, are strongly associated with worsening SOFA score trends in sepsis. Serial SOFA monitoring may help identify vulnerable patients requiring aggressive management.

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