Trends in mortality after a sepsis hospitalization: A nationwide prospective registry study from 2008-2021

Skei, Nina Vibeche; Nilsen, Tom Ivar Lund; Mohus, Randi Marie; Prescott, H.C.; Lydersen, Stian; Solligård, Erik; Damås, Jan Kristian; Gustad, Lise Tuset

doi:10.21203/rs.3.rs-2718744/v1

Cited by 3 publications

(1 citation statement)

References 40 publications

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“…Sepsis mortality is a serious concern in healthcare, as it remains one of the leading causes of death worldwide ( 1 ). Early identification and prediction of sepsis risk are crucial to improve patient outcomes ( 2 ).…”

mentioning

confidence: 99%

Editorial: Outcome of sepsis and prediction of mortality risk

Munari,

Minicucci,

Ming

et al. 2023

Front. Med.

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mentioning

confidence: 99%

Editorial: Outcome of sepsis and prediction of mortality risk

Munari,

Minicucci,

Ming

et al. 2023

Front. Med.

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Number of ICD-10 diagnosis fields required to capture sepsis in administrative data and truncation bias: A nationwide prospective registry study

Skei,

Damås,

Gustad

2024

Preprint

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BackgroundIn observational studies that uses administrative data, it is essential to report technical details such as the number of International Classification of Disease (ICD) coding fields extracted. This information is crucial for ensuring comparability between studies and for avoiding truncation bias in estimates, particularly for complex conditions like sepsis. Specific sepsis codes (explicit sepsis) is suggested identified by extracting 15 diagnosis fields, while for implicit sepsis, comprising an infection code combined with an acute organ failure, the number of diagnosis field remains unknown.ObjectiveThe objective was to explore the necessary number of diagnosis fields to capture explicit and implicit sepsis.Materials and methodsWe conducted a study utilizing The Norwegian Patient Register (NPR), which encompasses all medical ICD-10 codes from specialized health services in Norway. Data was extracted for all adult patients with hospital admissions registered under explicit and implicit sepsis codes from all Norwegian hospitals between 2008 through 2021.ResultsIn 317,705 sepsis admissions, we observed that 105,499 ICD-10 codes were identified for explicit sepsis, while implicit sepsis was identified through 270,346 codes for infection in combination with 240,586 codes for acute organ failure. Through our analysis, we found that 55.3%, 37.0%, and 10.0% of the explicit, infection, and acute organ failure codes, respectively, were documented as the main diagnosis. The proportion of explicit and infection codes peaked in main diagnosis field, while for acute organ failure codes this was true in the third diagnosis field. Notably, the cumulative proportion reached 99% in diagnosis field 11 for explicit codes and in diagnosis field 14 for implicit codes.ConclusionExpanding the utilization of multiple diagnosis fields can enhance the comparability of data in epidemiological studies, both internationally and within countries. To make truncation bias visible, reporting guidelines should specify the number of diagnosis fields when extracting ICD-10 codes.

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Return to work after hospitalization for sepsis: a nationwide, registry-based cohort study

Skei,

Moe,

Nilsen

et al. 2023

Crit Care

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Background Sepsis survivors commonly experience functional impairment, which may limit return to work. We investigated return to work (RTW) of patients hospitalized with sepsis and the associations with patient and clinical characteristics. Methods Working-age patients (18–60 years) admitted to a Norwegian hospital with sepsis between 2010 and 2021 were identified using the Norwegian Patient Registry and linked to sick-leave data from the Norwegian National Social Security System Registry. The main outcome was proportion of RTW in patients hospitalized with sepsis at 6 months, 1 year, and 2 years after discharge. Secondary outcomes were time trends in age-standardized proportions of RTW and probability of sustainable RTW (31 days of consecutive work). The time trends were calculated for each admission year, reported as percentage change with 95% confidence interval (CI). Time-to-event analysis, including crude and adjusted hazard risk (HRs), was used to explore the association between sustainable RTW, characteristics and subgroups of sepsis patients (intensive care unit (ICU) vs. non-ICU and COVID-19 vs. non-COVID-19). Results Among 35.839 hospitalizations for sepsis among patients aged 18–60 years, 12.260 (34.2%) were working prior to hospitalization and included in this study. The mean age was 43.7 years. At 6 months, 1 year, and 2 years post-discharge, overall estimates showed that 58.6%, 67.5%, and 63.4%, respectively, were working. The time trends in age-standardized RTW for ICU and non-ICU sepsis patients remained stable over the study period, except the 2-year age-standardized RTW for non-ICU patients that declined by 1.51% (95% CI − 2.22 to − 0.79) per year, from 70.01% (95% CI 67.21 to 74.80) in 2010 to 57.04% (95% CI 53.81–60.28) in 2019. Characteristics associated with sustainable RTW were younger age, fewer comorbidities, and fewer acute organ dysfunctions. The probability of sustainable RTW was lower in ICU patients compared to non-ICU patients (HR 0.56; 95% CI 0.52–0.61) and higher in patients with COVID-19-related sepsis than in sepsis patients (HR 1.31; 95% CI 1.15–1.49). Conclusion Absence of improvement in RTW proportions over time and the low probability of sustainable RTW in sepsis patients need attention, and further research to enhance outcomes for sepsis patients is required.

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Trends in mortality after a sepsis hospitalization: A nationwide prospective registry study from 2008-2021

Cited by 3 publications

References 40 publications

Editorial: Outcome of sepsis and prediction of mortality risk

Editorial: Outcome of sepsis and prediction of mortality risk

Number of ICD-10 diagnosis fields required to capture sepsis in administrative data and truncation bias: A nationwide prospective registry study

Return to work after hospitalization for sepsis: a nationwide, registry-based cohort study

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