Community-, Healthcare-, and Hospital-Acquired Severe Sepsis Hospitalizations in the University HealthSystem Consortium

Abstract

Objectives Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis hospitalizations in a national hospital sample. Setting United States Interventions None Measurements & Main Results Prevalence of community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis, adjusted hospital mortality, length of hospitalization, length of stay in an ICU, and hospital costs. Among 3,355,753 hospital discharges, there were 307,491 with severe sepsis, including 193,081 (62.8%) community-acquired severe sepsis, 79,581 (25.9%) healthcare-associated severe sepsis, and 34,829 (11.3%) hospital-acquired severe sepsis. Hospital-acquired severe sepsis and healthcare-associated severe sepsis exhibited higher in-hospital mortality than community-acquired severe sepsis (hospital-acquired [19.2%] vs healthcare-associated [12.8%] vs community-acquired [8.6%]). Hospital-acquired severe sepsis had greater resource utilization than both healthcare-associated severe sepsis and community-acquired severe sepsis, with higher median length of hospital stay (hospital acquired [17 d] vs healthcare associated [7 d] vs community-acquired [6 d]), median length of ICU stay (hospital-acquired [8 d] vs healthcare-associated [3 d] vs community-acquired [3 d]), and median hospital costs (hospital-acquired [$38,369] vs healthcare-associated [$8,796] vs community-acquired [$7,024]). Conclusions In this series, severe sepsis hospitalizations included CA-SS (62.8%), HCA-SS (25.9%) and HA-SS (11.3%) cases. HA-SS was associated with both higher mortality and resource utilization than CA-SS and HCA-SS.

Prolonged length of stay in the emergency department and increased risk of hospital mortality in patients with sepsis requiring ICU admission

“…Thus, the mortality can be higher with the updated third definition. In our study, we used the definition proposed by Angus  et al ,10 which was subsequently used in identifying patients with sepsis from EHR 12. Patients identified in this way were generally consistent with the third sepsis definition.…”

“…Sepsis was defined as a diagnosis of infection plus acute organ dysfunction 10 11. The definition was proposed by Angus  et al ,10 and was subsequently used in identifying patients with sepsis from electronic health record (EHR) 12…”

Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia

“…This was based on a meta-analysis of the literature and a large cohort study of sepsis patients, demonstrating the prognostic value of lactate >2 mmol/L for mortality in sepsis [14]. CAP is regarded a major source of sepsis [33]; accordingly, recommendations of adequate sepsis management have been incorporated within recent CAP guidelines [9] and implemented within CAP management bundles [26]. One study evaluating the effect of sepsis bundle implementation in CAP patients revealed that lactate measurement was independently associated with lower mortality [27].…”

Derivation of Novel Risk Prediction Scores for Community-Acquired Sepsis and Severe Sepsis*

“…Because of our focus on “community-acquired” rather than “hospital-acquired” sepsis, we did not utilize clinical data from later points of hospitalization. (16)…”

“…We are currently linking REGARDS participants to their corresponding Medicare claims, which may allow identification of hospital-acquired or healthcare-associated sepsis. (16)…”