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. 2022 Jul;162(1):101-110.
doi: 10.1016/j.chest.2022.01.016. Epub 2022 Jan 20.

Prevalence and Outcomes of Previously Healthy Adults Among Patients Hospitalized With Community-Onset Sepsis

Mohammad Alrawashdeh  1 , Michael Klompas  2 , Steven Q Simpson  3 , Sameer S Kadri  4 , Russell Poland  5 , Jeffrey S Guy  5 , Jonathan B Perlin  5 , Chanu Rhee  2 ; CDC Prevention Epicenters Program
Affiliations

Prevalence and Outcomes of Previously Healthy Adults Among Patients Hospitalized With Community-Onset Sepsis

Mohammad Alrawashdeh et al. Chest. 2022 Jul.

Abstract

Background: Devastating cases of sepsis in previously healthy patients have received widespread attention and have helped to catalyze state and national mandates to improve sepsis detection and care. However, it is unclear what proportion of patients hospitalized with sepsis previously were healthy and how their outcomes compare with those of patients with comorbidities.

Research question: Among adults hospitalized with community-onset sepsis, how many previously were healthy and how do their outcomes compare with those of patients with comorbidities?

Study design and methods: We retrospectively identified all adults with community-onset sepsis hospitalized in 373 US hospitals from 2009 through 2015 using clinical indicators of presumed infection and organ dysfunction (Centers for Disease Control and Prevention's Adult Sepsis Event criteria). Comorbidities were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We applied generalized linear mixed models to measure the associations between the presence or absence of comorbidities and short-term mortality (in-hospital death or discharge to hospice), adjusting for severity of illness on admission.

Results: Of 6,715,286 hospitalized patients, 337,983 (5.0%) were hospitalized with community-onset sepsis. Most patients with sepsis (329,052 [97.4%]) had received a diagnosis of at least one comorbidity; only 2.6% previously were healthy. Patients with sepsis who previously were healthy were younger than those with comorbidities (mean age, 58.0 ± 19.8 years vs 67.0 ± 16.5 years), were less likely to require ICU care on admission (37.9% vs 50.5%), and were more likely to be discharged home (57.9% vs 45.6%), rather than to subacute facilities (16.3% vs 30.8%), but showed higher short-term mortality rates (22.8% vs 20.8%; P < .001 for all). The association between previously healthy status and higher short-term mortality persisted after risk adjustment (adjusted OR, 1.99; 95% CI, 1.87-2.13).

Interpretation: The vast majority of patients hospitalized with community-onset sepsis harbor pre-existing comorbidities. However, previously healthy patients may be more likely to die when they seek treatment at the hospital with sepsis compared with patients with comorbidities. These findings underscore the importance of early sepsis recognition and treatment for all patients.

Keywords: comorbidity; epidemiology; infection; mortality; sepsis.

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Figures

Figure 1
Figure 1
Bar graph showing prevalence of comorbidities in hospitalized patients with and without community-onset sepsis.
Figure 2
Figure 2
Graph showing the adjusted risk for short-term mortality and prevalence of different comorbidities among patients with community-onset sepsis. ORs are adjusted for demographics, severity of illness on admission, and type of infection. Prevalence percentages do not sum to 100% because patients can have multiple comorbidities.
See this image and copyright information in PMC

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References

    1. Buchman T.G., Simpson S.Q., Sciarretta K.L., et al. Sepsis among Medicare beneficiaries: 1. The burdens of sepsis, 2012-2018. Crit Care Med. 2020;48(3):276–288. - PMC - PubMed
    1. Rhee C., Jones T.M., Hamad Y., et al. Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Netw Open. 2019;2(2) - PMC - PubMed
    1. Staunton O., Staunton C. The urgency of now: attacking the sepsis crisis. Crit Care Med. 2018;46(5):809–810. - PubMed
    1. Kerrigan S.W., Martin-Loeches I. Public awareness of sepsis is still poor: we need to do more. Intensive Care Med. 2018;44(10):1771–1773. - PubMed
    1. Hershey T.B., Kahn J.M. State sepsis mandates—a new era for regulation of hospital quality. N Engl J Med. 2017;376(24):2311–2313. - PubMed

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