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Anne Marie Hochhalter died Feb. 16 of  — an extreme reaction to infection — and complications from her paralysis were a “significant contributing factor� in her death, the Jefferson County Coroner’s Office said in an autopsy report obtained Thursday. She was 43.

Twelve students and one teacher were shot and killed April 20, 1999, in the attack on Columbine. The two student gunmen took their own lives.

Hochhalter’s brother, Nathan Hochhalter, said a pressure sore, a common problem for people living with paralysis, led to sepsis. He said he knew his sister’s life would likely be shorter because of her paralysis but her death this early was unexpected.

“We didn’t think it would be this bad this soon,� he said.

Hochhalter struggled with intense pain from her gunshot wounds in the years following the shooting, but fought hard to to overcome the complications of her injuries and remain positive, relatives and friends said. She was tireless in her drive to help others, including people with disabilities and members of her family, and she loved dogs, they said.

Hochhalter chose to forgive the mother of one of the gunmen, writing in a 2016 letter to Sue Klebold: “’A good friend once told me, ‘Bitterness is like swallowing a poison pill and expecting the other person to die.’ It only harms yourself. I have forgiven you and only wish you the best."

Hochhalter’s own tragedy was compounded six months after the shooting, when her mother, Carla Hochhalter, died by suicide. Anne Marie Hochhalter said her mother suffered from depression, and she did not believe the shootings were directly to blame for her mother's death.

After her mother's death, she became the “acquired daughter� of another family that lost a child, Lauren Townsend, in the Columbine shooting.

Townsend’s stepmother, Sue Townsend, reached out to help Hochhalter as a way to cope with her own grief. Eventually, Hochhalter joined the family for dinners and on vacations.

“She brought a light to our lives that will shine for a long time,� Townsend said.

Hochhalter attended a vigil marking the 25th anniversary of the shooting last year, after skipping a similar event five years earlier because of post-traumatic stress disorder, she said in a social media post.

This time she said she was flooded with happy memories from her childhood and said she wanted those killed to be remembered for how they lived, not how they died.

“I’ve truly been able to heal my soul since that awful day in 1999,� she wrote.