Prediction models for mortality in patients with sepsis: a systematic review and meta-analysis.

Background: Sepsis remains a leading cause of mortality among critically ill patients worldwide. Although an increasing number of prediction models have been published in recent years, their predictive performance, methodological quality, and major predictors have not been comprehensively evaluated in a systematic and quantitative manner. This study aims to evaluate the performance of these models and to identify common predictors associated with sepsis mortality. Methods: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for studies on sepsis mortality prediction models published up to July 1, 2025. Data were extracted and appraised using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS), and risk of bias was assessed with the Prediction Model Risk of Bias Assessment Tool for Artificial Intelligence (PROBAST+AI). Meta-analyses were performed to pool area under the curve of the receiver operating characteristic (AUC) metric of externally validated models and the odds ratio (OR) of common predictors. The study was registered in PROSPERO (CRD42024604119). Results: A total of 84 eligible studies were included, reporting 235 prediction models for sepsis mortality and involving approximately 2.7 million patient records reported across studies, with 461,387 deaths. Only 11(13.10%) studies encompassed model development, internal validation, and external validation. The included studies comprised 78(92.86%) retrospective cohort studies, 57(67.86%) studies developed in intensive care unit (ICU) settings, with MIMIC databases being among the most commonly used data sources. The most prevalent mortality endpoints were in-hospital ( Conclusion: Externally validated prediction models generally demonstrate moderate discriminative performance for predicting sepsis mortality, but a substantial proportion of these studies were evaluated as having a high risk of bias. Age, lactate, albumin, SOFA score, and vasopressor use were identified as predictors of mortality. Future studies with larger cohorts, rigorous designs, and multicenter external validation are warranted to improve their generalizability and facilitate clinical implementation. Systematic review registration: The unique registration identifier is CRD42024604119, and the publicly accessible website is https://www.crd.york.ac.uk/prospero/.