Cardiovascular Events and Hospital Deaths Among Patients With Severe Sepsis

Abstract

The burden of cardiovascular events among patients hospitalized with severe sepsis and the association of these events with in-hospital mortality is not well known. We examined the incidence of cardiovascular events and their association with in-hospital mortality among patients with severe sepsis. Patients with severe sepsis from the New York State Inpatient Database from 2012 through 2014 were identified using a validated International Classification of Diseases 9th Revision, Clinical Modification code 995.92. The primary outcome was the incidence of cardiovascular events during the hospitalizations, defined as a composite of ischemic, acute heart failure, or arrhythmic events and the secondary outcome was in-hospital mortality. Multivariable logistic regression models were used to compare the risk of in-hospital mortality among severe sepsis patients with and without cardiovascular events. A total of 117,418 patients (mean age, 70.8 years; 50.4% males, 59.5% whites) with severe sepsis occurred during the study period 2012 to 2014. New-onset (incident) cardiovascular event occurred in 13.1%, ischemic events in 4.5%, acute heart failure events in 2.3%, and arrhythmic events in 8.0% of patients, respectively. An estimated 32.9% of patients with severe sepsis died during their hospitalization. Severe sepsis patients with new-onset cardiovascular events were associated with 30% higher odds for in-hospital mortality (odds ratio: 1.30; 95% CI: 1.23 to 1.37, p < 0.001) as compared with patients without cardiovascular events in multivariable adjusted model. In conclusion, among patients with severe sepsis, incident cardiovascular events occur frequently. Further research is required to improve recognition and treatment of new-onset cardiovascular events in patients with severe sepsis.

Figure 1.. Flow diagram describing selection of patients with severe sepsis.

CV: Cardiovascular.

Figure 2.. Bar graph displaying the rates of cardiovascular events and their components per 100 patients with severe sepsis.

Data are presented as number of events with standard error per 100 patients with severe sepsis. CV: Cardiovascular, AMI: Acute myocardial infarction, A-fib: Atrial fibrillation, A-Flutter: Atrial flutter, AV: Atroventricular, VT: Ventricular tachycardia, SVT: Supraventricular tachycardia.

Figure 3.. Heat map of the relative contribution of factors that were associated with cardiovascular events in multivariate models.

The bicolor scale is displayed on the right. The darker red tones denote a greater percentage contribution of factor or variable to the global Wald score for association of a specific outcome. The numbers in boxes indicate the percentage contribution. CV: Cardiovascular; DNR: Do not resuscitate; HF: Heart failure.