Late mortality after sepsis: propensity matched cohort study

doi:10.1136/bmj.i2375

Observational Study

. 2016 May 17:353:i2375.

doi: 10.1136/bmj.i2375.

Late mortality after sepsis: propensity matched cohort study

Hallie C Prescott¹, John J Osterholzer², Kenneth M Langa³, Derek C Angus⁴, Theodore J Iwashyna⁵

Affiliations

¹ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA VA Center for Clinical Management Research, Health Services Research and DevelopmentCenter of Innovation, Ann Arbor, MI, USA Pulmonary Section, Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
² Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Pulmonary Section, Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
³ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA VA Center for Clinical Management Research, Health Services Research and DevelopmentCenter of Innovation, Ann Arbor, MI, USA Institute for Social Research, Ann Arbor, MI, USA.
⁴ Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁵ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA VA Center for Clinical Management Research, Health Services Research and DevelopmentCenter of Innovation, Ann Arbor, MI, USA Pulmonary Section, Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA Institute for Social Research, Ann Arbor, MI, USA Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

PMID: 27189000
PMCID: PMC4869794
DOI: 10.1136/bmj.i2375

Observational Study

Late mortality after sepsis: propensity matched cohort study

Hallie C Prescott et al. BMJ. 2016.

. 2016 May 17:353:i2375.

doi: 10.1136/bmj.i2375.

Authors

Hallie C Prescott¹, John J Osterholzer², Kenneth M Langa³, Derek C Angus⁴, Theodore J Iwashyna⁵

Affiliations

¹ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA VA Center for Clinical Management Research, Health Services Research and DevelopmentCenter of Innovation, Ann Arbor, MI, USA Pulmonary Section, Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
² Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Pulmonary Section, Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
³ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA VA Center for Clinical Management Research, Health Services Research and DevelopmentCenter of Innovation, Ann Arbor, MI, USA Institute for Social Research, Ann Arbor, MI, USA.
⁴ Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁵ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA VA Center for Clinical Management Research, Health Services Research and DevelopmentCenter of Innovation, Ann Arbor, MI, USA Pulmonary Section, Medical Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA Institute for Social Research, Ann Arbor, MI, USA Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

PMID: 27189000
PMCID: PMC4869794
DOI: 10.1136/bmj.i2375

Abstract

Objectives: To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

Deign: Observational cohort study.

Setting: US Health and Retirement Study.

Participants: 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

Main outcome measures: Late (31 days to two years) mortality and odds of death at various intervals.

Results: Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

Conclusions: More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None — **Fig 1** Flow of participants and match of patients with sepsis

See this image and copyright information in PMC

Comment in

Late mortality after sepsis.
Brett SJ. Brett SJ. BMJ. 2016 May 17;353:i2735. doi: 10.1136/bmj.i2735. BMJ. 2016. PMID: 27189069 Free PMC article.
Long term mortality following sepsis.
Kennelly PJ, Martin-Loeches I. Kennelly PJ, et al. Ann Transl Med. 2016 Oct;4(19):387. doi: 10.21037/atm.2016.08.31. Ann Transl Med. 2016. PMID: 27827464 Free PMC article. No abstract available.
Role of sepsis in delayed mortality.
Kaur A, Levy MM. Kaur A, et al. Ann Transl Med. 2016 Oct;4(19):378. doi: 10.21037/atm.2016.08.24. Ann Transl Med. 2016. PMID: 27827468 Free PMC article. No abstract available.

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References

1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10. 10.1097/00003246-200107000-00002 pmid:11445675. - DOI - PubMed
1. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014;311:1308-16. 10.1001/jama.2014.2637. pmid:24638143. - DOI - PubMed
1. Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med 2014;42:625-31. 10.1097/CCM.0000000000000026. pmid:24201173. - DOI - PMC - PubMed
1. Miller RR 3rd, , Dong L, Nelson NC, et al. Intermountain Healthcare Intensive Medicine Clinical Program. Multicenter implementation of a severe sepsis and septic shock treatment bundle. Am J Respir Crit Care Med 2013;188:77-82. 10.1164/rccm.201212-2199OC. pmid:23631750. - DOI - PMC - PubMed
1. Prescott HC, Kepreos KM, Wiitala WL, Iwashyna TJ. Temporal Changes in the Influence of Hospitals and Regional Healthcare Networks on Severe Sepsis Mortality. Crit Care Med 2015;43:1368-74. 10.1097/CCM.0000000000000970. pmid:25803652. - DOI - PMC - PubMed

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[1] Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10. 10.1097/00003246-200107000-00002 pmid:11445675. - DOI - PubMed

[2] Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-10. 10.1097/00003246-200107000-00002 pmid:11445675. - DOI - PubMed

[3] Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014;311:1308-16. 10.1001/jama.2014.2637. pmid:24638143. - DOI - PubMed

[4] Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014;311:1308-16. 10.1001/jama.2014.2637. pmid:24638143. - DOI - PubMed

[5] Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med 2014;42:625-31. 10.1097/CCM.0000000000000026. pmid:24201173. - DOI - PMC - PubMed

[6] Stevenson EK, Rubenstein AR, Radin GT, Wiener RS, Walkey AJ. Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*. Crit Care Med 2014;42:625-31. 10.1097/CCM.0000000000000026. pmid:24201173. - DOI - PMC - PubMed

[7] Miller RR 3rd, , Dong L, Nelson NC, et al. Intermountain Healthcare Intensive Medicine Clinical Program. Multicenter implementation of a severe sepsis and septic shock treatment bundle. Am J Respir Crit Care Med 2013;188:77-82. 10.1164/rccm.201212-2199OC. pmid:23631750. - DOI - PMC - PubMed

[8] Miller RR 3rd, , Dong L, Nelson NC, et al. Intermountain Healthcare Intensive Medicine Clinical Program. Multicenter implementation of a severe sepsis and septic shock treatment bundle. Am J Respir Crit Care Med 2013;188:77-82. 10.1164/rccm.201212-2199OC. pmid:23631750. - DOI - PMC - PubMed

[9] Prescott HC, Kepreos KM, Wiitala WL, Iwashyna TJ. Temporal Changes in the Influence of Hospitals and Regional Healthcare Networks on Severe Sepsis Mortality. Crit Care Med 2015;43:1368-74. 10.1097/CCM.0000000000000970. pmid:25803652. - DOI - PMC - PubMed

[10] Prescott HC, Kepreos KM, Wiitala WL, Iwashyna TJ. Temporal Changes in the Influence of Hospitals and Regional Healthcare Networks on Severe Sepsis Mortality. Crit Care Med 2015;43:1368-74. 10.1097/CCM.0000000000000970. pmid:25803652. - DOI - PMC - PubMed

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Late mortality after sepsis: propensity matched cohort study

Affiliations

Late mortality after sepsis: propensity matched cohort study

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Abstract

Conflict of interest statement

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