Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization

Walkey, Allan J.; Knox, Daniel; Myers, Laura C.; Thai, Khanh K.; Jacobs, Jason R.; Kipnis, Patricia; Desai, Manisha; Go, Alan S.; Lu, Yun; Brown, Samuel M.; Martínez, Adriana; Clancy, Heather; Devis, Ycar; Liu, Vincent X

doi:10.1097/cce.0000000000000674

Cited by 6 publications

(9 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study builds upon previous research demonstrating the increased risk of subsequent cardiovascular disease in sepsis survivors (e.g., compared with nonsepsis survivors of a hospitalization) (18, 20–23, 45, 46). Our results are consistent with findings from recent cohort studies highlighting that an elevated troponin value, sepsis-specific variables, and presepsis characteristics were associated with subsequent cardiovascular events (24, 27, 47). Our study provides additional information on preexisting comorbidities, cardiovascular and sepsis-specific characteristics that are likely associated with subsequent cardiovascular disease and assessing the risk over a longer follow-up and using population-based data.…”

Section: Discussionsupporting

confidence: 93%

“…However, the risk factors for these cardiovascular complications remain uncertain-and the extent to which subsequent cardiovascular events are due to classic pathways (e.g., baseline risk factors such as hypertension) or sepsis-related complications is unknown (24). Better understanding of associated risk factors could potentially help 1) generate hypothesis for translational research models and 2) identify subgroups of patients at low or high risk of cardiovascular disease (12,18,(25)(26)(27). This could in turn inform the enrichment of future trials evaluating potential preventative strategies (e.g., statin use after discharge) (28).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Major Cardiovascular Events in Adult Sepsis Survivors: A Population-Based Cohort Study*

Angriman

Rosella

Lawler

et al. 2023

Critical Care Medicine

View full text Add to dashboard Cite

OBJECTIVES: To describe risk factors for major cardiovascular events in adults following hospital discharge after sepsis. DESIGN: Population-based cohort study. SETTING: Ontario, Canada (2008–2017). PATIENTS: Adult patients (age 18 yr or older) who survived a first sepsis hospitalization without preexisting cardiovascular disease. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary composite outcome was myocardial infarction, stroke, or cardiovascular death up to 5 years following hospital discharge. We used cause-specific Cox proportional hazards models that accounted for the competing risk of noncardiovascular death to describe factors associated with major cardiovascular events. We identified 268,259 adult patients without cardiovascular disease (median age, 72 yr), of whom 10.4% experienced a major cardiovascular event during a median follow-up of 3 years. After multivariable adjustment, age (hazard ratio [HR], 1.53 for every 10 yr; 95% CI, 1.51–1.54), male sex (HR, 1.23; 95% CI, 1.20–1.26), diabetes mellitus (HR, 1.24; 95% CI, 1.21–1.27), hypertension (HR, 1.34; 95% CI, 1.30–1.38), prevalent atrial fibrillation (HR, 1.46; 95% CI, 1.40–1.52), and chronic kidney disease (HR, 1.11; 95% CI, 1.06–1.16) were associated with major cardiovascular events during long-term follow-up. Sepsis characteristics such as site of infection (pneumonia vs other: HR, 1.09; 95% CI, 1.05–1.12), septic shock (HR, 1.08; 95% CI, 1.05–1.11), and renal replacement therapy (HR, 1.51; 95% CI, 1.38–1.64) were also associated with subsequent cardiovascular events. In an analysis restricting to patients with troponin values measured during the hospitalization (26,400 patients), an elevated troponin was also associated with subsequent cardiovascular events (HR, 1.23; 95% CI, 1.13–1.33). CONCLUSIONS: Classic cardiovascular risk factors, comorbid conditions, and characteristics of the sepsis episode were associated with a higher hazard of major cardiovascular events in adult sepsis survivors. These findings may inform enrichment strategies for future studies.

show abstract

Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Risk Factors for Major Cardiovascular Events in Adult Sepsis Survivors: A Population-Based Cohort Study*

Angriman

Rosella

Lawler

et al. 2023

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Pre-existing diabetes represents a classic cardiovascular risk factor in the general population, whereas mounting evidence from observational studies show the increased risk of cardiovascular disease in sepsis survivors [ 14 – 16 , 27 , 51 – 53 ]. Furthermore, the potential role for diabetes as an independent risk factor for cardiovascular disease in adult sepsis survivors has also been recently highlighted [ 21 , 23 , 54 ]. Prior studies have shown how, among other baseline comorbidities and characteristics of the sepsis episode, pre-existing diabetes may be associated with a higher risk of cardiovascular disease following sepsis; however, these studies were not designed specifically to quantify the impact of diabetes and were undertaken mostly within a prediction framework [ 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalent diabetes and long-term cardiovascular outcomes in adult sepsis survivors: a population-based cohort study

Angriman,

Lawler,

Shah

et al. 2023

Crit Care

View full text Add to dashboard Cite

Background Sepsis survivors are at elevated risk for cardiovascular disease during long-term follow-up. Whether diabetes influences cardiovascular risk after sepsis survival remains unknown. We sought to describe the association of diabetes with long-term cardiovascular outcomes in adult sepsis survivors. Methods Population-based cohort study in the province of Ontario, Canada (2008–2017). Adult survivors of a first sepsis-associated hospitalization, without pre-existing cardiovascular disease, were included. Main exposure was pre-existing diabetes (any type). The primary outcome was the composite of myocardial infarction, stroke, and cardiovascular death. Patients were followed up to 5 years from discharge date until outcome occurrence or end of study period (March 2018). We used propensity score matching (i.e., 1:1 to patients with sepsis but no pre-existing diabetes) to adjust for measured confounding at baseline. Cause-specific Cox proportional hazards models with robust standard errors were used to estimate hazard ratios (HR) alongside 95% confidence intervals (CI). A main secondary analysis evaluated the modification of the association between sepsis and cardiovascular disease by pre-existing diabetes. Results 78,638 patients with pre-existing diabetes who had a sepsis-associated hospitalization were matched to patients hospitalized for sepsis but without diabetes. Mean age of patients was 71 years, and 55% were female. Median duration from diabetes diagnosis was 9.8 years; mean HbA1c was 7.1%. Adult sepsis survivors with pre-existing diabetes experienced a higher hazard of major cardiovascular disease (HR 1.25; 95% CI 1.22–1.29)—including myocardial infarction (HR 1.40; 95% CI 1.34–1.47) and stroke (HR 1.24; 95% CI 1.18–1.29)—during long-term follow-up compared to sepsis survivors without diabetes. Pre-existing diabetes modified the association between sepsis and cardiovascular disease (risk difference: 2.3%; 95% CI 2.0–2.6 and risk difference: 1.8%; 95% CI 1.6–2.0 for the effect of sepsis—compared to no sepsis—among patients with and without diabetes, respectively). Conclusions Sepsis survivors with pre-existing diabetes experience a higher long-term hazard of major cardiovascular events when compared to sepsis survivors without diabetes. Compared to patients without sepsis, the absolute risk increase of cardiovascular events after sepsis is higher in patients with diabetes (i.e., diabetes intensified the higher cardiovascular risk induced by sepsis).

show abstract

“…We conducted a retrospective cohort study of patients ≥40 years old who survived a hospitalization for sepsis at 21 KPNC hospitals admitted between January 1, 2011 and September 30, 2017 with new‐onset AF. We previously described the cohort inclusion/exclusion criteria 8 . Briefly, AF was present on the cardiac rhythm flow sheet using a previously validated method that scans flowsheets to estimate time spent in certain heart rhythms 9 .…”

Section: Methodsmentioning

confidence: 99%

Predicting stroke risk after sepsis hospitalization with new‐onset atrial fibrillation

Myers,

Peltan,

Thai

et al. 2024

Journal of Hospital Medicine

Self Cite

View full text Add to dashboard Cite

BackgroundNew‐onset atrial fibrillation (AF) during sepsis is common, but models designed to stratify stroke risk excluded patients with secondary AF. We assessed the predictive validity of CHA2DS2VASc scores among patients with new‐onset AF during sepsis and developed a novel stroke prediction model incorporating presepsis and intrasepsis characteristics.MethodsWe included patients ≥40 years old who survived hospitalizations with sepsis and new‐onset AF across 21 Kaiser Permanente Northern California hospitals from January 1, 2011 to September 30, 2017. We calculated the area under the receiver operating curve (AUC) for CHA2DS2VASc scores to predict stroke or transient ischemic attack (TIA) within 1 year after a hospitalization with new‐onset AF during sepsis using Fine‐Gray models with death as competing risk. We similarly derived and validated a novel model using presepsis and intrasepsis characteristics associated with 1‐year stroke/TIA risk.ResultsAmong 82,748 adults hospitalized with sepsis, 3992 with new‐onset AF (median age: 80 years, median CHA2DS2VASc of 4) survived to discharge, among whom 70 (2.1%) experienced stroke or TIA outcome and 1393 (41.0%) died within 1 year of sepsis. The CHA2DS2VASc score was not predictive of stroke risk after sepsis (AUC: 0.50, 95% confidence interval [CI]: 0.48–0.52). A newly derived model among 2555 (64%) patients in the derivation set and 1437 (36%) in the validation set included 13 variables and produced an AUC of 0.61 (0.49–0.73) in derivation and 0.54 (0.43–0.65) in validation.ConclusionCurrent models do not accurately stratify risk of stroke following new‐onset AF secondary to sepsis. New tools are required to guide anticoagulation decisions following new‐onset AF in sepsis.

show abstract

Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization

Cited by 6 publications

References 36 publications

Risk Factors for Major Cardiovascular Events in Adult Sepsis Survivors: A Population-Based Cohort Study*

Risk Factors for Major Cardiovascular Events in Adult Sepsis Survivors: A Population-Based Cohort Study*

Prevalent diabetes and long-term cardiovascular outcomes in adult sepsis survivors: a population-based cohort study

Predicting stroke risk after sepsis hospitalization with new‐onset atrial fibrillation

Contact Info

Product

Resources

About