Conducting Sepsis Surveillance by Applying Sepsis-3 Criteria to Electronic Health Record Data: Promises and Potential Pitfalls*

Rhee, Chanu

doi:10.1097/ccm.0000000000005223

Cited by 5 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite therapeutic advances over the last two decades, the high mortality rate associated with sepsis confirms why sepsis is considered a challenging clinical obstacle in intensive care medicine [ 41 , 42 ]. Such a situation confirms the existence of a knowledge gap in sepsis research, which requires ongoing research.…”

Section: Discussionmentioning

confidence: 99%

Effect of Celecoxib and Infliximab against Multiple Organ Damage Induced by Sepsis in Rats: A Comparative Study

et al. 2022

View full text Add to dashboard Cite

In cases of sepsis, the immune system responds with an uncontrolled release of proinflammatory cytokines and reactive oxygen species. The lungs, kidneys, and liver are among the early impacted organs during sepsis and are a direct cause of mortality. The aim of this study was to compare the effects of infliximab (IFX) and celecoxib (CLX) on septic rats that went through a cecal ligation and puncture (CLP) surgery to induce sepsis. This study included four groups: sham, CLP (untreated), and CLP-treated with CLX or IFX. The administration of “low dose” CLX or IFX was performed after 2 h following the induction of sepsis. Twenty-four hours following the induction of sepsis, the rats were sacrificed and blood samples were collected to evaluate kidney, liver, and lung injuries. MDA and NOx content, in addition to SOD activity and GSH levels, were evaluated in the tissue homogenates of each group. Tissue samples were also investigated histopathologically. In a separate experiment, the same groups were employed to evaluate the survival of septic rats in a 7-day observation period. The results of this study showed that treatment with either CLX or IFX ameliorated the three organs’ damage compared to septic-untreated rats, decreased oxidative stress, enhanced the antioxidant defense, and reduced serum cytokines. As a result, a higher survival rate resulted: 62.5% and 37.5% after the administration of CLX and IFX, respectively, compared to 0% in the CLP group after 7 days. No significant differences were observed between the two agents in all measured parameters. Histopathological examination confirmed the observed results. In conclusion, CLX and IFX ameliorated lung, kidney, and liver injuries associated with sepsis through anti-inflammatory and antioxidant actions, which correlated to the increase in survival observed with both of them.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of Celecoxib and Infliximab against Multiple Organ Damage Induced by Sepsis in Rats: A Comparative Study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Many advocate the use of clinical data to define the epidemiology of sepsis. 18 , 22 , 23 , 24 In a study of data from 7 health systems, Rhee et al 24 identified sepsis hospitalizations using clinical data such as blood cultures, antibiotic and vasopressor administration, mechanical ventilation, and laboratory test measures. The incidence of sepsis in the Rhee et al 24 study was 60 per 1000 hospitalizations; although lower than the Angus estimate and higher than the explicit sepsis estimate, this figure is very similar to the Martin et al 6 and SEP‐1 estimates observed in our study.…”

Section: Discussionmentioning

confidence: 99%

“… 18 , 22 , 23 , 24 In a study of data from 7 health systems, Rhee et al 24 identified sepsis hospitalizations using clinical data such as blood cultures, antibiotic and vasopressor administration, mechanical ventilation, and laboratory test measures. The incidence of sepsis in the Rhee et al 24 study was 60 per 1000 hospitalizations; although lower than the Angus estimate and higher than the explicit sepsis estimate, this figure is very similar to the Martin et al 6 and SEP‐1 estimates observed in our study. However, although similar to the CAS mortality seen with explicit sepsis codes, the 15% mortality observed in the Rhee study is far higher than the CAS and HCAS mortality that we observed with the Martin, Angus, and SEP‐1 taxonomies.…”

Section: Discussionmentioning

confidence: 99%

“…For example, it is difficult to identify infections in electronic health records or the elements of the sequential organ failure assessment (SOFA). 22 There is even disagreement about the clinical parameters that comprise sepsis. 25 …”

Section: Discussionmentioning

confidence: 99%

“…Discharge data cannot capture key measures important to identifying and characterizing sepsis including vital signs, use of antibiotics, and the timing of infection and organ dysfunction. Many advocate the use of clinical data to define the epidemiology of sepsis 18,22–24 . In a study of data from 7 health systems, Rhee et al 24 identified sepsis hospitalizations using clinical data such as blood cultures, antibiotic and vasopressor administration, mechanical ventilation, and laboratory test measures.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Updated estimates of sepsis hospitalizations at United States academic medical centers

et al. 2022

View full text Add to dashboard Cite

Objective Sepsis is a major public health problem. Understanding the epidemiology of sepsis subtypes is important to quantify the magnitude of the problem and identify targets for system wide treatment strategies. We sought to describe the current national epidemiology of community‐acquired (CAS), hospital‐acquired (HAS) and healthcare‐associated sepsis (HCAS) hospitalizations among academic medical centers in the United States using current discharge diagnosis taxonomies. Methods Retrospective analysis of patient discharge data from the Vizient Clinical Data Base/Resource Manager. We identified sepsis hospitalizations using four ICD‐10 coding strategies: (1) “Martin” sepsis codes (21 ICD‐10 codes), (2) “Angus” sepsis codes (ICD‐10 infection + ICD‐10 organ dysfunction), (3) Medicare “SEP‐1” codes (28 ICD‐10 codes), and (4) “explicit sepsis” codes (ICD‐10 R65.20 and R65.21). Using present‐on‐admission flags for each diagnosis, we also distinguished: (1) community‐acquired sepsis (CAS), (2) hospital‐acquired sepsis (HAS), and (3) healthcare associated sepsis (HCAS). Results Among 22,655,240 hospitalizations, the number and incidence of sepsis hospitalizations were: (1) Martin (n = 1,718,257, 75.8 per 1000 hospitalizations), (2) Angus (n = 2,749,163, 121.3 per 1000), (3) SEP‐1 (n = 1,624,909, 71.7 per 1000), and (4) explicit sepsis (n = 655,853, 28.9 per 1000). CAS was the most common sepsis subtype. HAS exhibited higher adjusted mortality than CAS. ICU admission was highest for HAS (Martin, 1.5%; Angus, 1.5%; SEP‐1, 1.6%; Explicit, 1.9%). Conclusions These results illustrate the prevalence of sepsis at US academic medical centers using the most current sepsis classification taxonomies and discharge diagnosis codes. These results highlight important considerations when using hospital discharge data to characterize the epidemiology of sepsis.

show abstract

Update on Sepsis Epidemiology in the Era of COVID-19

Shappell

Rhee

2023

Semin Respir Crit Care Med

Self Cite

View full text Add to dashboard Cite

Timely and accurate data on the epidemiology of sepsis is essential to inform public policy, clinical practice, and research priorities. Recent studies have illuminated several ongoing questions about sepsis epidemiology, including the incidence and outcomes of sepsis in non-Western countries and in specialized populations such as surgical patients, patients with cancer, and the elderly. There have also been new insights into the limitations of current surveillance methods using administrative data and increasing experience tracking sepsis incidence and outcomes using “big data” approaches that take advantage of detailed electronic health record data. The COVID-19 pandemic, however, has fundamentally changed the landscape of sepsis epidemiology. It has increased sepsis rates, helped highlight ongoing controversies about how to define sepsis, and intensified debate about the possible unintended consequences of overly rigid sepsis care bundles. Despite these controversies, there is a growing consensus that severe COVID-19 causing organ dysfunction is appropriate to label as sepsis, even though it is treated very differently from bacterial sepsis, and that surveillance strategies need to be modified to reliably identify these cases to fully capture and delineate the current burden of sepsis. This review will summarize recent insights into the epidemiology of sepsis and highlight several urgent questions and priorities catalyzed by COVID-19.

show abstract

Conducting Sepsis Surveillance by Applying Sepsis-3 Criteria to Electronic Health Record Data: Promises and Potential Pitfalls*

Cited by 5 publications

References 16 publications

Effect of Celecoxib and Infliximab against Multiple Organ Damage Induced by Sepsis in Rats: A Comparative Study

Effect of Celecoxib and Infliximab against Multiple Organ Damage Induced by Sepsis in Rats: A Comparative Study

Updated estimates of sepsis hospitalizations at United States academic medical centers

Update on Sepsis Epidemiology in the Era of COVID-19

Contact Info

Product

Resources

About