In a very large cohort of patients who developed sepsis during hospitalization, residual risk of death and all-cause and major cardiovascular disease, regardless of whether they were hospitalized for sepsis or developed sepsis during treatment. Hospitalizations related to (CVD) events were more likely. According to the results of a new retrospective analysis. especially, heart failure was the most commonly reported CVD event and the CVD event with the highest risk associated with hospitalization-related sepsis.
The survey results were published online today American Heart Association Journal.
“We know that infection can be a potential trigger for myocardial infarction and heart attack, and that infection can predispose patients to other cardiovascular events,” said the lead study author. Jacob C. Jentzer, MD, FAHA, Mayo Clinic, Rochester, Minnesota. in a statement. “We sought to explain the association between sepsis during hospitalization and subsequent death and readmission in a large group of adults.”
For the analysis, we examined data from the OptumLabs data warehouse for 2,258,464 patients hospitalized for non-surgical reasons between January 1, 2009 and December 31, 2019. This data source is a repository of billing and enrollment records for both corporate and Medicare Advantage enrollees. In total, these patients have followed her over 5 million patient-years. Each hospital stay must be at least 2 nights, International Classification of Diseases, 9th revision/10th revision Explicit and implicit diagnostic codes were used to categorize hospital charges. The research period ended on December 31, 2020.
Of the overall study population, 35.8% (n = 808,673) experienced sepsis-related hospitalization. Breaking down this total, 55.5% (n = 448,644) had implicit sepsis only, 15.4% (n = 124,841) had explicit sepsis only, and 29.1% (n = 235,188) had both.
The researchers’ analysis also found a 27% increase in all-cause mortality (HR, 1.27; 95% CI, 1.25-1.28; P. < .001), all-cause readmission rate was 38% (HR, 1.38; 95% CI, 1.37–1.39; P. < .001), and CVD-related hospitalization was 43% (HR, 1.43; 95% CI, 1.41–1.44; P. < .001) among patients with documented cases of sepsis during hospitalization. Among CVD-related hospitalizations, heart failure had the highest sepsis-related risk, 51% (HR, 1.51; 95% CI, 1.49-1.53).
Patients in this study had a mean (SD) of 64.4 (14.6) years, consisted of a majority of female patients (54.4%), lived in the Southern United States (45.8%), and were eligible for Medicare Advantage (53.6%). ) was. %).
Patients with and without sepsis were significantly different in the following characteristics, respectively:
- Older patients (55-64, 65-74, 75+): 84.6% vs 69.0%
- Medicare Advantage participants: 68.1% vs. 45.6%
- History of previous CVD: 61.4% vs 44.3%
- CVD during index hospitalization: 56.1% vs. 44.9%
- Sepsis/bacteremia during index hospitalization: 20.8% vs. 0.2%
- Lung infection during index hospitalization: 34.3% vs. 4.7%
- Organ failure during index hospitalization: 84.9% vs. 23.3%
- Mean length of hospital stay: 6.7 (7.5) vs 4.2 (4.2) days
Within the group of sepsis patients, those with only occult sepsis were older (> 75 years), in 44.5% vs. 29.0% of patients with frank sepsis alone and 40.5% of patients with both types.In addition, patients with potential sepsis are more susceptible to coronary artery disease, heart failure, atrial fibrillation, stroke, and implantable devices (all P. < .001).
Sensitivity analysis findings continued an increased trend for sepsis patients, and the risk of all-cause mortality, all-cause readmission, and CVD hospitalization were all increased in this group ( all P. < .001):
- Overall mortality: 33% (HR, 1.33; 95% CI, 1.32-1.35)
- All-cause readmission: 47% (HR, 1.47; 95% CI, 1.46-1.48)
- Hospitalization for CVD: 52% (HR, 1.52; 95% CI, 1.50-1.54)
Investigators noted that the increased risk is not temporary. Both had early onset within 6–12 months after admission and persisted during the 12-year study follow-up period. They also emphasized that their findings mirror much of the existing literature of increased short-term and long-term risks for patients who survive sepsis infection.
In addition, the strength of their findings included the inclusion of high-risk patients “to ensure that low-risk patients were not used as a comparison group,” and robustness in the broader study population. I pointed out that the methodology is included.
Going forward, they urge healthcare providers to continue to pay attention to the changing risk status of patients after sepsis infection, especially those who volunteer for hospitalization with an early, low-risk condition. Discharged.
An accompanying editorial underlines the importance of the study’s findings, pointing out that the study is the largest to date of an association between sepsis and post-discharge adverse events.
“Many questions remain, but the findings in this article should alert providers to the importance of sepsis episodes as major events in a patient’s history,” the editorial authors wrote. Prompt attention and recognition of the post-discharge burden of sepsis, coupled with meticulous post-discharge care and cardiovascular risk stratification, could potentially improve patient-centered outcomes. ”
reference
Jentzer JC, Lawler PR, Van Houten HK, Yao X, Kashani KB, Dunlay SM. Cardiovascular events in survivors of sepsis hospitalization: a retrospective cohort analysis. J am Hart AssociatePublished online February 1, 2023. doi:10.1161/JAHA.122.027813
