Measurement of Sepsis in a National Cohort Using Three Different Methods to Define Baseline Organ Function

Wayne, Max T; Molling, Daniel; Wang, Xiao Qing; Hogan, Cainnear K; Seelye, Sarah; Liu, Vincent X; Prescott, Hallie C.

doi:10.1513/annalsats.202009-1130oc

Cited by 9 publications

(20 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Baseline organ function was measured via a 6-month look-back of laboratory data, as in prior studies. 20 …”

Section: Resultsmentioning

confidence: 99%

“…Temporal Trends and Hospital Variation in Time-to-Antibiotics for Treatment of Sepsis continued on antibiotics for at least 4 consecutive days (or died prior to 4 days while receiving consecutive days of antibiotics); and had objective evidence of acute organ dysfunction 20 within 48 hours of presentation. We further limited our cohort to hospitalizations at facilities with at least 15 eligible hospitalizations so that we could reliably measure variation across hospitals.…”

Section: Jama Network Open | Critical Care Medicinementioning

confidence: 99%

“…b Comorbidities were identified from International Classification of Diseases, Ninth Revision (ICD-9) and International Classification of Diseases, Tenth Revision (ICD-10) codes in inpatient and outpatient encounters in the 1.5 years preceding hospitalization and classified according to Elixhauser criteria.c Acute organ dysfunction was identified from the electronic health record and defined as the following: elevated lactate required lactic acid greater than 18.02 mg/dL (to convert to millimoles per liter, multiply by 0.111); kidney dysfunction required a creatinine greater than 1.2 mg/dL (to ventilation. Baseline organ function was measured via a 6-month look-back of laboratory data, as in prior studies 20.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis

et al. 2021

Self Cite

View full text Add to dashboard Cite

IMPORTANCE It is unclear whether antimicrobial timing for sepsis has changed outside of performance incentive initiatives. OBJECTIVE To examine temporal trends and variation in time-to-antibiotics for sepsis in the US Department of Veterans Affairs (VA) health care system. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study included 130 VA hospitals from 2013 to 2018. Participants included all patients admitted to the hospital via the emergency department with sepsis from 2013 to 2018, using a definition adapted from the Centers for Disease Control and Prevention Adult Sepsis Event definition, which requires evidence of suspected infection, acute organ dysfunction, and systemic antimicrobial therapy within 12 hours of presentation. Data were analyzed from October 6, 2020, to July 1, 2021.EXPOSURES Time from presentation to antibiotic administration. MAIN OUTCOMES AND MEASURESThe main outcome was differences in time-to-antibiotics across study periods, hospitals, and patient subgroups defined by presenting temperature and blood pressure. Temporal trends in time-to-antibiotics were measured overall and by subgroups. Hospitallevel variation in time-to-antibiotics was quantified after adjusting for differences in patient characteristics using multilevel linear regression models.RESULTS A total of 111 385 hospitalizations for sepsis were identified, including 107 547 men (96.6%) men and 3838 women (3.4%) with a median (interquartile range [IQR]) age of 68 (62-77) years. A total of 7574 patients (6.8%) died in the hospital, and 13 855 patients (12.4%) died within 30 days. Median (IQR) time-to-antibiotics was 3.9 (2.4-6.5) hours but differed by presenting characteristics. Unadjusted median (IQR) time-to-antibiotics decreased over time, from 4.5 (2.7-7.1) hours during 2013 to 2014 to 3.5 (2.2-5.9) hours during 2017 to 2018 (P < .001). In multilevel models adjusted for patient characteristics, median time-to-antibiotics declined by 9.0 (95% CI, 8.8-9.2) minutes per calendar year. Temporal trends in time-to-antibiotics were similar across patient subgroups, but hospitals with faster baseline time-to-antibiotics had less change over time, with hospitals in the slowest tertile decreasing time-to-antibiotics by 16.6 minutes (23.1%) per year, while hospitals in the fastest tertile decreased time-to-antibiotics by 7.2 minutes (13.1%) per year. In the most recent years (2017)(2018), median time-to-antibiotics ranged from 3.1 to 6.7 hours across hospitals (after adjustment for patient characteristics), 6.8% of variation in time-to-antibiotics was explained at the hospital level, and odds of receiving antibiotics within 3 hours increased by 65% (95% CI, 56%-77%) for the median patient if moving to a hospital with faster time-to-antibiotics.

show abstract

“…Baseline organ function was measured via a 6-month look-back of laboratory data, as in prior studies. 20 …”

Section: Resultsmentioning

confidence: 99%

Section: Jama Network Open | Critical Care Medicinementioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Wayne et al compared this approach to best values during hospitalization or 90 days prior, and best values during hospitalization or 180 days prior. 42 They reported an 11 to 17% increase in the number of hospitalizations that qualified as community-acquired sepsis when using definitions with longer lookback periods (100,568 hospitalizations when using best value during hospitalization as baseline; 111,983 hospitalizations with a 90-day look back; and 117,435 hospitalizations with a 180-day look back). Patient characteristics, length of stay, and in-hospital mortality (7.2, 7.0, and 6.8%), were similar between approaches.…”

Section: Methodologic Approaches To Sepsis Surveillancementioning

confidence: 99%

“…Wayne et al compared this approach to best values during hospitalization or 90 days prior, and best values during hospitalization or 180 days prior. 42 They reported an 11 to 17% increase in the number of hospitalizations that qualified as community-acquired sepsis when using definitions with longer lookback periods (100,568 hospitalizations when Update on Sepsis Epidemiology in the Era of COVID- 19 Shappell et al 175 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.…”

Section: Clinical Data From Electronic Health Records: Cdc's Adult Se...mentioning

confidence: 99%

Update on Sepsis Epidemiology in the Era of COVID-19

Shappell

Rhee

2023

Semin Respir Crit Care Med

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

Temporal Trends in Antimicrobial Prescribing During Hospitalization for Potential Infection and Sepsis

et al. 2022

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Some experts have cautioned that national and health system emphasis on rapid administration of antimicrobials for sepsis may increase overall antimicrobial use even among patients without sepsis.OBJECTIVE To assess whether temporal changes in antimicrobial timing for sepsis are associated with increasing antimicrobial use, days of therapy, or broadness of antimicrobial coverage among all hospitalized patients at risk for sepsis. DESIGN, SETTING, AND PARTICIPANTSThis is an observational cohort study of hospitalized patients at 152 hospitals in 2 health care systems during 2013 to 2018, admitted via the emergency department with 2 or more systemic inflammatory response syndrome (SIRS) criteria. Data analysis was performed from June 10, 2021, to March 22, 2022.EXPOSURES Hospital-level temporal trends in time to first antimicrobial administration.OUTCOMES Antimicrobial outcomes included antimicrobial use, days of therapy, and broadness of antibacterial coverage. Clinical outcomes included in-hospital mortality, 30-day mortality, length of hospitalization, and new multidrug-resistant (MDR) organism culture positivity.RESULTS Among 1 559 523 patients admitted to the hospital via the emergency department with 2 or more SIRS criteria (1 269 998 male patients [81.4%]; median [IQR] age, 67 [59-77] years), 273 255 (17.5%) met objective criteria for sepsis. In multivariable models adjusted for patient characteristics, the adjusted median (IQR) time to first antimicrobial administration to patients with sepsis decreased by 37 minutes, from 4.7 (4.1-5.3) hours in 2013 to 3.9 (3.6-4.4) hours in 2018, although the slope of decrease varied across hospitals. During the same period, antimicrobial use within 48 hours, days of antimicrobial therapy, and receipt of broad-spectrum coverage decreased among the broader cohort of patients with SIRS. In-hospital mortality, 30-day mortality, length of hospitalization, new MDR culture positivity, and new MDR blood culture positivity decreased over the study period among both patients with sepsis and those with SIRS. When examining hospital-specific trends, decreases in antimicrobial use, days of therapy, and broadness of antibacterial coverage for patients with SIRS did not differ by hospital antimicrobial timing trend for sepsis. Overall, there was no evidence that accelerating antimicrobial timing for sepsis was associated with increasing antimicrobial use or impaired antimicrobial stewardship. CONCLUSIONS AND RELEVANCEIn this multihospital cohort study, the time to first antimicrobial for sepsis decreased over time, but this trend was not associated with increasing antimicrobial use, days of therapy, or broadness of antimicrobial coverage among the broader population at-risk for sepsis, which suggests that shortening the time to antibiotics for sepsis is feasible without leading to indiscriminate antimicrobial use.

show abstract

Measurement of Sepsis in a National Cohort Using Three Different Methods to Define Baseline Organ Function

Cited by 9 publications

References 38 publications

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis

Update on Sepsis Epidemiology in the Era of COVID-19

Temporal Trends in Antimicrobial Prescribing During Hospitalization for Potential Infection and Sepsis

Contact Info

Product

Resources

About