Assessment of Health Care Exposures and Outcomes in Adult Patients With Sepsis and Septic Shock

Fay, Katherine; Sapiano, Mathew R. P.; Gokhale, Runa; Dantes, Raymund; Thompson, Nicola D.; Katz, David; Ray, Susan M.; Wilson, Lucy; Perlmutter, Rebecca; Nadle, Joelle; Godine, Deborah; Frank, Linda; Brousseau, Geoff; Johnston, Helen; Bamberg, Wendy; Dumyati, Ghinwa; Nelson, Dallas; Lynfield, Ruth; DeSilva, Malini B.; Kainer, Marion A.; Zhang, Alexia; Ocampo, Valerie; Samper, Monika; Pierce, Rebecca; Irizarry, Lourdes; Sievers, Marla; Maloney, Meghan; Fiore, Anthony E.; Magill, Shelley S.; Epstein, Lauren

doi:10.1001/jamanetworkopen.2020.6004

Cited by 50 publications

(50 citation statements)

References 16 publications

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“…Similar to other studies, a higher incidence was observed for males compared with females, for very young infants or elderly, and for patients with comorbidities 13 23 30–33. Indeed, ageing is associated with increased prevalence of chronic diseases and impaired immune system, thus increasing the risk of sepsis 32.…”

Section: Discussionsupporting

confidence: 83%

Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

et al. 2022

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ObjectiveThis study aims to provide a case definition of sepsis of presumed bacterial aetiology based on 10th revision of the International Classification of Diseases (ICD-10) codes, to assess trends in sepsis incidence and mortality between 2015 and 2019 in France, and to describe the characteristics of affected patients and hospital stays.DesignNationwide, population-based, retrospective observational study.SettingMetropolitan France between 2015 and 2019.ParticipantsBetween 2015 and 2019, 1 224 433 patients with sepsis of presumed bacterial aetiology were selected from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d’Information) and were identified from corresponding ICD-10 codes for explicit sepsis or implicit sepsis.Main outcomes measuresAnnual overall and age-specific and gender-specific incidence and 95% CI, as well as trends in sepsis incidence and mortality, were estimated. Comorbidities, length of hospital stay and outcomes were described.ResultsThe sex-standardised and age-standardised incidence per 100 000 (95% CI) increased from 357 (356.0 to 359.0) in 2015 to 403 (401.9 to 405.0) in 2019 and remained higher for males compared with females. Children under 1 year and patients over 75 years consistently had the highest incidence. The most common comorbidities were cancer and chronic heart failure. The median hospital length of stay was 12 days. Most patients came from home, but only half returned home after their hospital stay and approximately 15% were discharged to long-term care. In-hospital mortality was about 25% and declined along the study period.ConclusionsMedico-administrative databases can be used to provide nationwide estimates of the in-hospital burden of bacterial sepsis. The results confirm the high burden of sepsis in France. These data should be complemented by estimating the additional burden associated with fungal and viral infections during the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 83%

Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

et al. 2022

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“…Other notable findings we observed in our review of included studies that were not reported consistently or easily quantified are summarized in Table 1 . Of the two studies investigating antibiotic use prior to admission, antibiotic use was noted to increase in the days leading up to a sepsis hospitalization and up to 73.4% of patients had received antibiotics in the 30 days prior ( 9 , 16 ). Documentation of infectious disease diagnoses or symptoms ranged from 27.0% to 80.5% ( 16 , 18 ).…”

Section: Resultsmentioning

confidence: 99%

“…Given that 80% of hospitalized patients with sepsis present from the community setting ( 9 , 10 ), patient encounters with the healthcare system in the week(s) prior to a sepsis hospitalization (prehospital encounters) represent opportunities for early identification of the transition from infection to sepsis, more intensive monitoring in certain patients, and potential opportunities for intervention to reverse course. Estimating the overall proportion of patients with a prehospital “touch point,” along with information about the healthcare setting and resulting clinical outcomes, is critical to inform potential interventions.…”

mentioning

confidence: 99%

Frequency and Types of Healthcare Encounters in the Week Preceding a Sepsis Hospitalization: A Systematic Review

Flannery¹,

Venn²,

Gusovsky³

et al. 2022

Critical Care Explorations

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OBJECTIVES: Early recognition and treatment are critical to improving sepsis outcomes. We sought to identify the frequency and types of encounters that patients have with the healthcare system in the week prior to a sepsis hospitalization. DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and the Cochrane Library. STUDY SELECTION: Observational cohort studies of patients hospitalized with sepsis or septic shock that were assessed for an outpatient or emergency department encounter with the healthcare system in the week prior to hospital admission. DATA EXTRACTION: The primary outcome was the proportion of patients with a healthcare encounter in the time period assessed (up to 1 week) prior to a hospitalization with sepsis. DATA SYNTHESIS: Six retrospective observational studies encompassing 6,785,728 sepsis admissions were included for evaluation, ranging from a 263-patient single-center cohort to a large database evaluating 6,731,827 sepsis admissions. The average (unweighted) proportion of patients having an encounter with the healthcare system in the week prior to a sepsis hospitalization was 32.7% and ranged from 10.3% to 52.9%. These encounters commonly involved presentation or potential symptoms of infectious diseases, antibiotic prescriptions, and appeared to increase in frequency closer to a sepsis hospitalization admission. No consistent factors were identified that distinguished a healthcare encounter as more or less likely to precede a sepsis hospitalization in the subsequent week. CONCLUSIONS: Patients that present to the hospital with sepsis are frequently evaluated in the healthcare system in the week prior to admission. Further research is necessary to understand if these encounters offer earlier opportunities for intervention to prevent the transition from infection to sepsis, whether they merely reflect the comorbidities of sepsis patients with a high baseline rate of healthcare encounters, or the declining trajectory of a patient’s overall health in response to infection.

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“…The patients' electronic or paper medical files were consistently reviewed for 4 calendar days or until discharge from the hospital. The primary endpoint of this study was the diagnosis of sepsis within 96 h. Our aim was to include all patients with communityacquired sepsis, since these are the most common ones [29,30] and usually present to EDs in need of early sepsis management [31]. Furthermore, the board of the clinical trial aimed to include late sepsis development so that early biomarker diagnostic performance could be assessed.…”

Section: Endpointsmentioning

confidence: 99%

Diagnostic Performance of Procalcitonin for the Early Identification of Sepsis in Patients with Elevated qSOFA Score at Emergency Admission

Bolanaki

Möckel

Winning³

et al. 2021

JCM

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Infectious biomarkers such as procalcitonin (PCT) can help overcome the lack of sensitivity of the quick Sequential Organ Failure Assessment (qSOFA) score for early identification of sepsis in emergency departments (EDs) and thus might be beneficial as point-of-care biomarkers in EDs. Our primary aim was to investigate the diagnostic performance of PCT for the early identification of septic patients and patients likely to develop sepsis within 96 h of admission to an ED among a prospectively selected patient population with elevated qSOFA scores. In a large multi-centre prospective cohort study, we included all adult patients (n = 742) with a qSOFA score of at least 1 who presented to the ED. PCT levels were measured upon admission. Of the study population 27.3% (n = 202) were diagnosed with sepsis within the first 96 h. The area under the curve for PCT for the identification of septic patients in EDs was 0.86 (95% confidence interval (CI): 0.83–0.89). The resultant sensitivity for PCT at a cut-off of 0.5 µg/l was 63.4% (95% CI: 56.3–70.0). Furthermore, specificity was 89.2% (95% CI: 86.3–91.7), the positive predictive value was 68.8% (95% CI: 62.9–74.2), and the negative predictive value was 86.7% (95% CI: 84.4–88.7). The early measurement of PCT in a patient population with elevated qSOFA score served as an effective tool for the early identification of sepsis in ED patients.

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Assessment of Health Care Exposures and Outcomes in Adult Patients With Sepsis and Septic Shock

Cited by 50 publications

References 16 publications

Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

Frequency and Types of Healthcare Encounters in the Week Preceding a Sepsis Hospitalization: A Systematic Review

Diagnostic Performance of Procalcitonin for the Early Identification of Sepsis in Patients with Elevated qSOFA Score at Emergency Admission

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