Updated estimates of sepsis hospitalizations at United States academic medical centers

Abstract

Objective Sepsis is a major public health problem. Understanding the epidemiology of sepsis subtypes is important to quantify the magnitude of the problem and identify targets for system wide treatment strategies. We sought to describe the current national epidemiology of community‐acquired (CAS), hospital‐acquired (HAS) and healthcare‐associated sepsis (HCAS) hospitalizations among academic medical centers in the United States using current discharge diagnosis taxonomies. Methods Retrospective analysis of patient discharge data from the Vizient Clinical Data Base/Resource Manager. We identified sepsis hospitalizations using four ICD‐10 coding strategies: (1) “Martin” sepsis codes (21 ICD‐10 codes), (2) “Angus” sepsis codes (ICD‐10 infection + ICD‐10 organ dysfunction), (3) Medicare “SEP‐1” codes (28 ICD‐10 codes), and (4) “explicit sepsis” codes (ICD‐10 R65.20 and R65.21). Using present‐on‐admission flags for each diagnosis, we also distinguished: (1) community‐acquired sepsis (CAS), (2) hospital‐acquired sepsis (HAS), and (3) healthcare associated sepsis (HCAS). Results Among 22,655,240 hospitalizations, the number and incidence of sepsis hospitalizations were: (1) Martin (n = 1,718,257, 75.8 per 1000 hospitalizations), (2) Angus (n = 2,749,163, 121.3 per 1000), (3) SEP‐1 (n = 1,624,909, 71.7 per 1000), and (4) explicit sepsis (n = 655,853, 28.9 per 1000). CAS was the most common sepsis subtype. HAS exhibited higher adjusted mortality than CAS. ICU admission was highest for HAS (Martin, 1.5%; Angus, 1.5%; SEP‐1, 1.6%; Explicit, 1.9%). Conclusions These results illustrate the prevalence of sepsis at US academic medical centers using the most current sepsis classification taxonomies and discharge diagnosis codes. These results highlight important considerations when using hospital discharge data to characterize the epidemiology of sepsis.

“All Models Are Wrong, Some Are Useful”: George Box

“…Their low, medium, and high sepsis prevalence scenarios are based on their own real-world data. Given that it draws from two extensive U.S. hospital systems and is broadly in line with estimates from other studies, their scenarios likely reflect sepsis prevalence in U.S. hospitals generally ( 8 ). The assumptions regarding spillover prescribing would be expected to demonstrate a shift toward harm.…”

Three-dimensional label-free morphology of CD8 + T cells as a sepsis biomarker

“…Sepsis is a “life-threatening organ dysfunction caused by the dysregulated host response to infection” 1 . Sepsis has high mortality rates 2 , 3 , and sepsis-specific treatment is lacking. One reason is that the immune response to sepsis is complex and varies among patients 4 .…”

Clinical decision support tools useful for identifying sepsis risk

“…3 However, the odds of death are three times higher when sepsis develops during the hospital stay as opposed to being acquired in the community. 4 Early recognition and treatment of patients with sepsis can lead to improved outcomes and reduced mortality. [5][6][7][8] Various clinical decision support tools (CDSTs) and existing early warning tools are used for the early identification of sepsis.…”

“…Sepsis is often community-acquired and present on arrival in 87% of all US adults admitted to the hospital with sepsis 3. However, the odds of death are three times higher when sepsis develops during the hospital stay as opposed to being acquired in the community 4. Early recognition and treatment of patients with sepsis can lead to improved outcomes and reduced mortality 5-8…”