Risk of out-of-hospital cardiac arrest among sepsis survivors in Taiwan: analysis of a nationwide population-based cohort

Abstract

ObjectivesThere is minimal literature examining the association of sepsis with out-of-hospital cardiac arrest (OHCA). Using a large national database, we aimed to quantify the risk of OHCA among sepsis patients after hospital discharge.DesignPopulation-based cohort study.SettingNationwide sepsis cohort retrieved from the National Health Insurance Research Database of Taiwan between 2000 and 2013.ParticipantsWe included 17 304 patients with sepsis. After hospital discharge, 144 patients developed OHCA within 30 days and 640 between days 31 and 365.Primary and secondary outcome measuresThe main outcomes were OHCA events following hospital discharge for sepsis. To evaluate the independent association between sepsis and OHCA after a sepsis hospitalisation, we constructed two non-sepsis comparison cohorts using risk set sampling and propensity score matching techniques (non-infection cohort, non-sepsis infection cohort). We plotted the daily number and daily risk of OHCA within 1 year of hospital discharge between sepsis and matched non-sepsis cohorts. We used Cox regression to evaluate the risk of early and late OHCA, comparing sepsis to non-sepsis patients.ResultsCompared with non-infected patients, sepsis patients had a higher rate of early (HR 1.66, 95% CI: 1.27 to 2.16) and late (HR 1.19, 95% CI: 1.06 to 1.33) OHCA events. This association was independent of age, sex or cardiovascular history. Compared with non-sepsis patients with infections, sepsis patients had a higher rate of both early (HR 1.28, 95% CI: 1.00 to 1.63) and late (HR 1.13, 95% CI: 1.01 to 1.27) OHCA events, especially among patients with cardiovascular disease (OR 1.35, 95% CI: 1.01 to 1.81).ConclusionsSepsis patients had increased risk of OHCA compared with matched non-sepsis controls, which lasted up to 1 year after hospital discharge.

Validation of ICD-9-CM and ICD-10-CM Diagnostic Codes for Identifying Patients with Out-of-Hospital Cardiac Arrest in a National Health Insurance Claims Database

“…Similar issues also arise in Hsu’s study that investigated the risk of OHCA among sepsis survivors in Taiwan, where the first-listed ICD-9-CM codes of 427.5 and 798 as well as a billing code for CPR were used to define OHCA. 7 Without adequate data on the validity of OHCA diagnosis, their study findings would be harder to interpret.…”

“…Several population-based OHCA studies have been conducted using administrative databases in the US 20–24 and outside the US 7 , 25 , 26 based on the above-mentioned validated OHCA-related diagnostic codes. However, because coding practices and reimbursement policies may differ across healthcare systems, it should not be taken for granted that the validity of case definitions established in one database can be extrapolated to another database.…”

“… 6 Hsu et al investigated the risk of OHCA among sepsis survivors in Taiwan between 2000 and 2013. 7 However, the validity of the International Classification of Diseases (ICD) diagnostic codes used to ascertain OHCA has not been adequately assessed in these studies. Besides, the coding system transition from ICD-9 to ICD-10 in Taiwan in 2016 may lead to inconsistent estimation of disease prevalence across the transition.…”