Sepsis Burden in a Major Romanian Emergency Center—An 18-Year Retrospective Analysis of Mortality and Risk Factors

<i>Background and Objectives:</i> Sepsis is a leading cause of morbidity and mortality worldwide, yet data from Central and Eastern Europe remain scarce. Our study aims to address the scarcity of information regarding the characteristics and mortality rates of patients with sepsis by reporting recent data from one of the largest emergency centers in Romania over an 18-year period (2007-2024). <i>Materials and Methods:</i> A retrospective analysis was conducted on 12,089 adult patients diagnosed with sepsis at the University Emergency Hospital of Bucharest. Patients were identified using International Classification of Diseases (ICD-10) codes and free-text diagnosis. Demographic and clinical data were extracted, including comorbidities, interventions, and mortality outcomes. Associations between comorbidities and in-hospital mortality were assessed using odds ratios (ORs) and 95% confidence intervals (CIs). <i>Results:</i> The study population had a mean age of 68.7 years, with a slight predominance of males (50.9%). In-hospital mortality was 53.9%, and 30-day mortality reached 85.1%. The most common comorbidities were diabetes (27.2%), chronic kidney disease (14.0%), and cancer (12.9%). Pneumonia (OR = 2.08, 95% CI: 1.89-2.28), cirrhosis (OR = 1.69, 95% CI: 1.40-2.03), and chronic obstructive pulmonary disease (OR = 1.50, 95% CI: 1.27-1.77) were strong predictors of mortality, while diabetes was associated with a slightly lower risk (OR = 0.90, 95% CI: 0.83-0.97). <i>Conclusions:</i> Sepsis-related mortality in Romania is higher than reported in Western Europe and North America, resembling trends in resource-limited settings. Targeted early recognition, antimicrobial stewardship, and improved intensive care units (ICU) resource allocation are crucial for reducing mortality. Multicenter studies and microbiological analyses are needed to further understand sepsis outcomes in this region.