Increased 1-Year Healthcare Use in Survivors of Severe Sepsis

Prescott, Hallie C.; Langa, Kenneth M.; Liu, Vincent; Escobar, Gabriel J.; Iwashyna, Theodore J.

doi:10.1164/rccm.201403-0471oc

Cited by 243 publications

(235 citation statements)

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“…Recent data suggest that health care utilization increases after sepsis (14)(15)(16)(17). As these studies were largely restricted to the elderly (15,16) or the most severely ill (14,16,17), and because all but one lacked a comparison group (14,15,17), essential questions remain unanswered.…”

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confidence: 99%

Post–Acute Care Use and Hospital Readmission after Sepsis

et al. 2015

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Rationale: The epidemiology of post-acute care use and hospital readmission after sepsis remains largely unknown.Objectives: To examine the rate of post-acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods:In an observational cohort study conducted in an academic health care system (2010-2012), we compared post-acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis.Measurements and Main Results: Post-acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P , 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P , 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0-26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38-1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P , 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge.Conclusions: Post-acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes.

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confidence: 99%

Post–Acute Care Use and Hospital Readmission after Sepsis

et al. 2015

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“…The readmission rate reported by Hill and colleagues is consistent with international trends found in other retrospective studies. Prescott and colleagues found 60% of their cohort admitted to US hospitals required re-admission within 12 months, while Liu and colleagues found 48% of their sample required re-admission within 12 months 10,11 . Goodwin and colleagues reported 48% of their cohort who had survived an ICU admission for severe sepsis required re-admission by 6 months 29 .…”

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confidence: 98%

“…Prescott and colleagues interrogated the Health and Retirement Study database, a longitudinal panel study 11 . They report a 1-year mortality of 44%.…”

Section: Discussionmentioning

confidence: 99%

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Long-term morbidity and mortality in survivors of critical illness: a 5-year observational follow-up study

Secombe

Stewart

2017

Rural Remote Health

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A B S T R A C TIntroduction: This prospective observational study over 5 years aimed to quantify long-term morbidity and mortality in a prospectively recruited cohort of Central Australian survivors of critical illness. Methods: Eligible participants are survivors of an intensive care unit (ICU) admission for a critical illness at the Alice Springs Hospital (ASH), prospectively recruited during 2009. The ASH ICU is a 10-bed unit located in Central Australia with approximately 600 admissions annually, 95% of which are emergent, and 65% Indigenous. All-cause mortality, secondary healthcare utilisation and functional outcomes were measured by 6-minute walk distance (an indicator of functional status) and the home and community care (HACC) screening tool at 5 years.Results: Sixty eight percent of the cohort had died at 5 years. Median age of death was 53 years with a median time to death of 604 days following ICU admission. There was increased secondary healthcare utilisation measured by emergency department presentations and hospital re-admissions, with a median 5.22 healthcare presentations per year alive. There is evidence of ongoing functional limitation with 6-minute walk distance at 5 years significantly less than that predicted, despite high scores on the HACC screening assessment suggesting virtually full resumption of basic and domestic activities of daily living. Conclusions: A critical illness is not an isolated event, and there is evidence of ongoing high secondary healthcare utilisation, reflecting a high burden of disease. Mortality in this cohort is higher than would be expected from international data, and at a young median age, suggesting significant loss of productive life years. In addition, there is evidence of ongoing morbidity, with higher rates of healthcare utilisation than comparable international studies. This has profound implications for healthcare planners due to the ongoing economic implications, and may suggest a need for increased primary healthcare resources to pre-emptively manage chronic disease and reduce the burden of healthcare utilisation at acute care facilities.© PJ Secombe, P Stewart, 2016. A Licence to publish this material has been given to James Cook University 2016, http://www.jcu.edu.au 2

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“…As mulheres parecem estar em menor risco de desenvolver sepse do que os homens (13) . Os pacientes que sobrevivem à sepse são mais propensos a serem internados em cuidados intensivos e / ou centros de cuidados prolongados no primeiro ano após a internação inicial e também parecem ter uma diminuição persistente na qualidade de vida (14)(15)(16)(17) .…”

Section: Introductionunclassified

Diagnóstico De Sepse Em Pacientes Após Internação Em Unidade De Terapia Intensiva

Moura¹,

Sanches²,

Pereira³

et al. 2017

ACS

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Conflito de interesses:Não Contribuição dos autores: JMM coleta, tabulação, delineamento do estudo e redação do manuscrito. EBS delineamento do estudo. RAPM delineamento do estudo e elaboração do manuscrito. ISF orientação do projeto, discussão dos achados, etapas de execução e elaboração do manuscrito, delineamento do estudo e elaboração do manuscrito. LMC orientação do projeto, delineamento do estudo e elaboração do manuscrito. ALW orientação do projeto, discussão dos achados, etapas de execução e elaboração do manuscrito, delineamento do estudo e elaboração do manuscrito. Contato para correspondência: Joice Marques Moura E-mail: joice_aww@hotmail. AbstractIntroduction: Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with sepsis (formerly called severe sepsis) should still be identified by the same organ dysfunction criteria (including lactate level greater than 2 mmol/L). Organ dysfunction may also be identified in the future using the quick Sepsis-Related Organ Failure Assessment (qSOFA). Currently, sepsis is one of the main causes of mortality in Intensive Care Units. In 2003, the Sepsis Surviving Campaign was created, elaborating a schedule of actions to reduce the incidence of sepsis, especially in intensive care units. Objective: To know the clinical characteristics and outcome of patients who developed sepsis during Intensive Care Units admission. Material and Methods: This is a retrospective, descriptive study using a quantitative approach performed at the Intensive Care Units. Data were obtained through an electronic medical record. The software Epi Info, version 7.2.1.0 was used to analyze data. Results:The largest number of patients hospitalized was male, aged from 51 to 70 years. The most common comorbidities were Systemic Hypertension, Diabetes Mellitus, alcoholism, smoking, and heart disease. The most analyzed post-sepsis outcome was discharge from Intensive Care Units, and the patients were considerably males. Conclusion: We conclude that the patients who most developed sepsis were men (62%), aged ranging from 51 to 70 years (36%). The main comorbidity was systemic hypertension (42%) and the most observed outcome was discharge from the Intensive Care Units (67%). consenso e novas definições de sepse foram publicadas, conhecidas como Sepsis 3, definida pela "presença de disfunção orgânica ameaçadora à vida secundária à resposta desregulada do organismo à infecção" (2) . Para avaliação do diagnóstico clínico de disfunção or gânica, atualmente são observados uma variação de dois ou mais pontos no escore Sequential Organ Failure Assessment (SOFA). Os critérios da síndrome da resposta inflamatória sistêmica (SRIS) não são mais usados para a definição. Os casos de sepse passam a ser considerados como doença grave, assim, não se usa mais a expressão "sepse grave". Choque séptico é definido como "um subgrupo dos pacientes com sepse que apresentam acentuadas anormalidades circulatórias, celulares e metabólicas e associadas com maio...

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Increased 1-Year Healthcare Use in Survivors of Severe Sepsis

Abstract: Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.

Cited by 243 publications

References 42 publications

Post–Acute Care Use and Hospital Readmission after Sepsis

Post–Acute Care Use and Hospital Readmission after Sepsis

Long-term morbidity and mortality in survivors of critical illness: a 5-year observational follow-up study

Diagnóstico De Sepse Em Pacientes Após Internação Em Unidade De Terapia Intensiva

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