Epidemiology and outcomes in patients with severe sepsis admitted to the hospital wards

Whittaker, Stacey-Ann; Fuchs, Barry D.; Gaieski, David F.; Christie, Jason D.; Goyal, Munish; Meyer, Nuala J.; Kean, Craig; Small, Dylan S.; Bellamy, Scarlett L.; Mikkelsen, Mark E.

doi:10.1016/j.jcrc.2014.07.012

Cited by 38 publications

(26 citation statements)

References 44 publications

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“…Although multiple population-level studies examined ICU utilization among obstetric patients [ 44 , 47 ], none focused specifically on severe sepsis. The rate of ICU admission in our study is markedly higher than that reported in the general population with severe sepsis [ 48 , 49 ]. It can be postulated that clinicians in the state may have had a lower threshold for ICU admission among pregnant patients with severe sepsis.…”

Section: Discussioncontrasting

confidence: 79%

Evolving Trends in the Epidemiology, Resource Utilization, and Outcomes of Pregnancy-Associated Severe Sepsis: A Population-Based Cohort Study

Oud

Watkins

2015

J Clin Med Res

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BackgroundInfections are a well-known complication of pregnancy. However, pregnancy-associated severe sepsis (PASS) has not been as well-characterized, with limited population-level data reported to date. We performed a population-based study of the evolving patterns of the epidemiology, clinical characteristics, resource utilization, and outcomes of PASS in Texas over the past decade.MethodsThe Texas Inpatient Public Use Data File was used to identify pregnancy-associated hospitalizations and PASS hospitalizations for the years 2001 - 2010. The Texas Center for Health Statistics reports of live births, abortions and fetal deaths, and a previously reported population-based, age-specific linkage study on miscarriage were used to derive the annual total estimated pregnancies (TEPs). The incidence, demographics, clinical characteristics, resource utilization and outcomes of PASS were examined. Logistic regression modeling was used to explore the predictors of PASS and its associated mortality.ResultsThere were 4,060,201 pregnancy-associated hospitalizations and 1,007 PASS hospitalizations during study period. The incidence of PASS was increased by 236% over the past decade, rising from 11 to 26 hospitalizations per 100,000 TEPs. The key changes between 2001 - 2002 and 2009 - 2010 within PASS hospitalizations included: admission to ICU 78% vs. 90% (P = 0.002); development of ≥ 3 organ failures 9% vs. 35% (P < 0.0001); and inflation-adjusted median hospital charges (2,010 dollars) $64,034 vs. $89,895 (P = 0.0141). Hospital mortality (11%) remained unchanged during study period. Chronic liver disease (adjusted odds ratio (aOR) 41.4) and congestive heart failure (CHF) (aOR 20.5) were associated with the highest risk of PASS, in addition to black race, poverty, drug abuse, and lack of health insurance. The highest risk of death was among women with HIV infection (aOR 45.5), need for mechanical ventilation (aOR 4.5), drug abuse (aOR 3.0), and lacking health insurance (aOR 2.9).ConclusionsThe incidence, severity, and fiscal burden of PASS rose substantially over the past decade. Case fatality was lower than that for severe sepsis in the general population. Chronic liver disease and CHF pose especially high risk of PASS. Pregnant women with history of drug abuse and lacking health insurance are at high risk of both developing and dying with PASS, requiring extra vigilance for early diagnosis and targeted intervention.

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Section: Discussioncontrasting

confidence: 79%

Evolving Trends in the Epidemiology, Resource Utilization, and Outcomes of Pregnancy-Associated Severe Sepsis: A Population-Based Cohort Study

Oud

Watkins

2015

J Clin Med Res

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“…Univariate testing did not detect significant differences in the rates or rapidity of critical therapeutic interventions among patients experiencing early death; whereas failure to normalize serum lactate (persistent lactate elevation), initial pH, and early blood culture positivity were significant predictors of early death in the univariate analysis. While some of these factors are known to predict in-hospital mortality or increased ICU lengths of stay in sepsis[6,14,15] to our knowledge this is the first study to associate these clinical features with mortality within the first 24 hours of presentation of sepsis. These findings may have implications for risk stratification of patients with severe sepsis or septic shock in addition to early identification of those in whom aggressive management may be needed to decrease risk of death or inform alternative goals of care.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors of early death from sepsis

Javed

Guirgis

Sterling

et al. 2017

Journal of Critical Care

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Purpose Patients with severe sepsis who experience rapid, early deterioration and death are of particular concern. Our objective was to identify predictors of early death in Emergency Department (ED) patients with severe sepsis. Methods Secondary analysis of two prospective studies of adult ED patients with severe sepsis. The primary outcome was early death, defined as death within 24 hours of triage. Results Out of 410 severe sepsis admissions, 20 patients experienced early death. These patients demonstrated significantly higher initial lactate (7.3 versus 3.3 mmol/L, p < 0.001) and modified SOFA (mSOFA) scores (10 vs 6, p<.001), were less likely to normalize their lactate (p<0.001), had lower initial pH (p<0.001), and more frequently had early positive blood cultures (p=0.021). Multivariable logistic regression identified initial serum lactate level (OR 1.19, 95% CI 1.06–1.35) and mSOFA score (OR 1.17, 95% CI 1.00–1.36) as independent predictors of early death. A repeat lactate ≥ 5 mmol/L had a sensitivity of 55% and specificity of 89% for early death. There were no significant treatment differences between groups. Conclusion Initial serum lactate and mSOFA score were independent predictors of mortality within 24 hours of ED admission in patients with severe sepsis.

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“… 39 In patients admitted to non-ICU settings, sepsis may not be detected well at any point during their hospital stay, as shown in our analysis of non-ICU patients. Although some studies have suggested that patients with severe sepsis are commonly admitted to non-ICU settings, 40 41 these studies have sometimes been based on administration of antibiotics in the ED as the criterion for suspected infection, or case identification using anecdotal screening rather than a developed objective instrument. In our anecdotal experience, most patients with an estimated mortality rate of 20% or higher at the time of hospital admission usually receive treatment in an ICU setting.…”

Section: Discussionmentioning

confidence: 99%

Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data

et al. 2015

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ObjectiveAdministrative health data are important for health services and outcomes research. We optimised and validated in intensive care unit (ICU) patients an International Classification of Disease (ICD)-coded case definition for sepsis, and compared this with an existing definition. We also assessed the definition's performance in non-ICU (ward) patients.Setting and participantsAll adults (aged ≥18 years) admitted to a multisystem ICU with general medicosurgical ICU care from one of three tertiary care centres in the Calgary region in Alberta, Canada, between 1 January 2009 and 31 December 2012 were included.Research designPatient medical records were randomly selected and linked to the discharge abstract database. In ICU patients, we validated the Canadian Institute for Health Information (CIHI) ICD-10-CA (Canadian Revision)-coded definition for sepsis and severe sepsis against a reference standard medical chart review, and optimised this algorithm through examination of other conditions apparent in sepsis.MeasuresSensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were calculated.ResultsSepsis was present in 604 of 1001 ICU patients (60.4%). The CIHI ICD-10-CA-coded definition for sepsis had Sn (46.4%), Sp (98.7%), PPV (98.2%) and NPV (54.7%); and for severe sepsis had Sn (47.2%), Sp (97.5%), PPV (95.3%) and NPV (63.2%). The optimised ICD-coded algorithm for sepsis increased Sn by 25.5% and NPV by 11.9% with slightly lowered Sp (85.4%) and PPV (88.2%). For severe sepsis both Sn (65.1%) and NPV (70.1%) increased, while Sp (88.2%) and PPV (85.6%) decreased slightly.ConclusionsThis study demonstrates that sepsis is highly undercoded in administrative data, thus under-ascertaining the true incidence of sepsis. The optimised ICD-coded definition has a higher validity with higher Sn and should be preferentially considered if used for surveillance purposes.

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Epidemiology and outcomes in patients with severe sepsis admitted to the hospital wards

Cited by 38 publications

References 44 publications

Evolving Trends in the Epidemiology, Resource Utilization, and Outcomes of Pregnancy-Associated Severe Sepsis: A Population-Based Cohort Study

Evolving Trends in the Epidemiology, Resource Utilization, and Outcomes of Pregnancy-Associated Severe Sepsis: A Population-Based Cohort Study

Clinical predictors of early death from sepsis

Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data

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