Inhospital death is a biased measure of fatal outcome from bloodstream infection

Laupland, Kevin B.; Pasquill, Kelsey; Parfitt, Elizabeth C.; Dagasso, Gabrielle; Gupta, Kaveri; Steele, Lisa

doi:10.2147/clep.s187381

Cited by 20 publications

(15 citation statements)

References 25 publications

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“…We can cautiously compare our results to those from previously published population-based studies, but it is important to note that the studies are from different time periods and populations, and the studies used a variety of mortality definitions. In-hospital mortality has been shown to be a biased measure of mortality at a general population-level [ 25 ] and is likely influenced by factors associated with health system and healthcare delivery. Regional-population based studies from Canberra (Australia; 2000–2004; in-hospital 7-day mortality), Calgary (Canada; 2000–2006; in-hospital), mid-Norway (Norway; 2002–2013; 30-day), Auckland (New Zealand; 2005–2011; in-hospital), and two Thai provinces (Thailand; 2008–2014; in-hospital) reported case fatality risks of 5, 11, 8.6, 9, and 8.9%, respectively [ 6 – 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The mortality rates for other causes of BSIs presented below were calculated by multiplying the reported case fatality risk by the incidence rate [ 5 ] if they were not reported in the manuscript. If the definition of mortality was in-hospital mortality, then the mortality rate is an underestimate of the true population mortality rate [ 25 ]. For Staphylococcus aureus BSIs, studies from Finland (2004–2007, 30-day), Calgary (Canada, 2000–2006, in-hospital), and Skaraborg (Sweden, 2003–2005, 30-day) identified case fatality risks of 16.9, 25 and 19.1%, respectively, and mortality rates of 3.5, 4.9 and 5.9 deaths/100,000 person-years, respectively [ 1 , 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

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Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

et al. 2021

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Background Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. Methods During 2014–2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014–2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. Results From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. Conclusions In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

et al. 2021

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“…However, many of these studies have been limited by small sample sizes [ 1 , 7 , 10 ], have been single centered [ 2 , 7 , 8 , 10 ], or have focussed on selected diagnoses or specific cohorts admitted to specialized ICUs [ 7 ]. In addition, while some national registry based studies have included very large sample sizes, they have been limited to acute care in-hospital outcomes only [ 3 , 23 ]. Our study benefits from its inclusion of a large number of admissions to four ICUs representing both tertiary referral and regional hospitals.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of prolonged critical illness: A multicentered study in North Brisbane, Australia

et al. 2021

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Background Although critical illness is usually of high acuity and short duration, some patients require prolonged management in intensive care units (ICU) and suffer long-term morbidity and mortality. Objective To describe the long-term survival and examine determinants of death among patients with prolonged ICU admission. Methods A retrospective cohort of adult Queensland residents admitted to ICUs for 14 days or longer in North Brisbane, Australia was assembled. Comorbid illnesses were classified using the Charlson definitions and all cause case fatality established using statewide vital statistics. Results During the study a total of 28,742 adult Queensland residents had first admissions to participating ICUs of which 1,157 (4.0%) had prolonged admissions for two weeks or longer. Patients with prolonged admissions included 645 (55.8%), 243 (21.0%), and 269 (23.3%) with ICU lengths of stay lasting 14–20, 21–27, and ≥28 days, respectively. Although the severity of illness at admission did not vary, pre-existing comorbid illnesses including myocardial infarction, congestive heart failure, kidney disease, and peptic ulcer disease were more frequent whereas cancer, cerebrovascular accidents, and plegia were less frequently observed among patients with increasing ICU lengths of stay lasting 14–20, 21–27, and ≥28 days. The ICU, hospital, 90-day, and one-year all cause case-fatality rates were 12.7%, 18.5%, 20.2%, and 24.9%, respectively, and were not different according to duration of ICU stay. The median duration of observation was 1,037 (interquartile range, 214–1888) days. Although comorbidity, age, and admitting diagnosis were significant, neither ICU duration of stay nor severity of illness at admission were associated with overall survival outcome in a multivariable Cox regression model. Conclusions Most patients with prolonged stays in our ICUs are alive at one year post-admission. Older age and previous comorbidities, but not severity of illness or duration of ICU stay, are associated with adverse long-term mortality outcome.

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“…Comorbidities were recorded as per Charlson et al [15], and episodes were classified as community-associated, healthcare-associated, and hospital-onset as per Friedman et al [16]. Death at 30-days post index infection was determined using provincial vital statistics information [17].…”

Section: Study Protocolmentioning

confidence: 99%

Burden of bloodstream infection in older persons: a population‐based study

et al. 2021

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Background Advancing age is a major risk factor for developing and dying from bloodstream infections (BSI). However, there is a paucity of population-based studies investigating the epidemiology of BSI in older persons. Objective To define the incidence, clinical determinants, and risk factors for death among those aged 65 years and older with BSI. Methods Population-based surveillance was conducted in the western interior of British Columbia, Canada, between April 1, 2010 and March 31, 2020. Chart reviews were conducted for clinical details and all cause case-fatality was established at 30-days follow-up. Results A total of 1854 incident BSI were identified among 1657 individuals aged 65 and older for an annual incidence of 533.9 per 100,000 population; the incidence for those aged 65-74, 75-84, and ≥85 years was 375.3, 678.9, and 1046.6 per 100,000 population, respectively. Males were at significantly increased risk as compared to females (incidence rate ratio, IRR 1.44; 95% confidence interval, CI, 1.32-1.59; p<0.0001). The crude annual incidence increased by 50% during the study. However, this was related to shift in population demographics with no increase evident following age- and sex-standardization. Older patients were more likely to have healthcare-associated infections and genitourinary sources and less likely to have bone/joint or soft tissue infections. The proportion of patients with underlying congestive heart failure, stroke, and dementia increased, whereas diabetes and liver disease decreased with older age. The overall 30-day all cause case-fatality rate was 22.0% (364/1657). After adjustment for clinical focus, onset of infection, etiology, and co-morbidity in a logistic model, those aged 75-84 years (odds ratio, OR, 1.66; 95% CI, 1.25-2.21) and ≥ 85 years (OR, 1.98; 95% CI, 1.41-2.77) were at significantly increased risk for death as compared to those aged 65-74 years. Conclusion Bloodstream infection is common in older persons and is a major cause of death. Countries with aging populations worldwide should expect an increase burden associated with BSI in the coming years.

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Inhospital death is a biased measure of fatal outcome from bloodstream infection

Cited by 20 publications

References 25 publications

Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study

Long-term outcome of prolonged critical illness: A multicentered study in North Brisbane, Australia

Burden of bloodstream infection in older persons: a population‐based study

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