TY - JOUR
T1 - Cardiovascular Events Among Survivors of Sepsis Hospitalization
T2 - A Retrospective Cohort Analysis
AU - Jentzer, Jacob C.
AU - Lawler, Patrick R.
AU - Van Houten, Holly K.
AU - Yao, Xiaoxi
AU - Kashani, Kianoush B.
AU - Dunlay, Shannon M.
N1 - Funding Information:
This study was made possible by indirect funding from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Mayo Clinic Department of Cardiovascular Medicine. Dr Dunlay is funded by the National Institutes of Health (R01 HL144529). Dr Lawler is supported by a Heart and Stroke Foundation of Canada National New Investigator career award.
Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/2/7
Y1 - 2023/2/7
N2 - BACKGROUND: Sepsis is associated with an elevated risk of late cardiovascular events among hospital survivors. METHODS AND RESULTS: We included OptumLabs Data Warehouse patients from 2009 to 2019 who survived a medical/ nonsurgical hospitalization lasting at least 2 nights. The association between sepsis during hospitalization, based on explicit and implicit discharge International Classification of Diseases, Ninth Revision (ICD-9)/Tenth Revision (ICD-10) diagnosis codes, with subsequent death and rehospitalization was analyzed using Kaplan–Meier survival analysis and multivariable Cox proportional-hazards models. The study population included 2 258 464 survivors of nonsurgical hospitalization (5 396 051 total patient-years of follow-up). A total of 808 673 (35.8%) patients had a sepsis hospitalization, including implicit sepsis only in 448 644, explicit sepsis only in 124 841, and both in 235 188. Patients with sepsis during hospitalization had an elevated risk of all-cause mortality (adjusted hazard ratio [HR], 1.27 [95% CI, 1.25–1.28]; P<0.001), all-cause rehospitalization (adjusted HR, 1.38 [95% CI, 1.37–1.39]; P<0.001), and cardiovascular hospitalization (adjusted HR, 1.43 [95% CI, 1.41–1.44]; P<0.001), especially heart failure hospitalization (adjusted HR, 1.51 [95% CI, 1.49–1.53]). Patients with implicit sepsis had higher risk than those with explicit sepsis. A sensitivity analysis using the first hospitalization yielded concordant results for cardiovascular hospitalization (adjusted HR, 1.78 [95% CI, 1.76–1.78]; P<0.001), as did a propensity-weighted analysis (adjusted HR, 1.52 [95% CI, 1.50–1.54]; P<0.001). CONCLUSIONS: Survivors of sepsis hospitalization are at elevated risk of early and late post-discharge death as well as cardiovascular and non-cardiovascular rehospitalization. This hazard spans the spectrum of cardiovascular events and may suggest that sepsis is an important cardiovascular risk factor.
AB - BACKGROUND: Sepsis is associated with an elevated risk of late cardiovascular events among hospital survivors. METHODS AND RESULTS: We included OptumLabs Data Warehouse patients from 2009 to 2019 who survived a medical/ nonsurgical hospitalization lasting at least 2 nights. The association between sepsis during hospitalization, based on explicit and implicit discharge International Classification of Diseases, Ninth Revision (ICD-9)/Tenth Revision (ICD-10) diagnosis codes, with subsequent death and rehospitalization was analyzed using Kaplan–Meier survival analysis and multivariable Cox proportional-hazards models. The study population included 2 258 464 survivors of nonsurgical hospitalization (5 396 051 total patient-years of follow-up). A total of 808 673 (35.8%) patients had a sepsis hospitalization, including implicit sepsis only in 448 644, explicit sepsis only in 124 841, and both in 235 188. Patients with sepsis during hospitalization had an elevated risk of all-cause mortality (adjusted hazard ratio [HR], 1.27 [95% CI, 1.25–1.28]; P<0.001), all-cause rehospitalization (adjusted HR, 1.38 [95% CI, 1.37–1.39]; P<0.001), and cardiovascular hospitalization (adjusted HR, 1.43 [95% CI, 1.41–1.44]; P<0.001), especially heart failure hospitalization (adjusted HR, 1.51 [95% CI, 1.49–1.53]). Patients with implicit sepsis had higher risk than those with explicit sepsis. A sensitivity analysis using the first hospitalization yielded concordant results for cardiovascular hospitalization (adjusted HR, 1.78 [95% CI, 1.76–1.78]; P<0.001), as did a propensity-weighted analysis (adjusted HR, 1.52 [95% CI, 1.50–1.54]; P<0.001). CONCLUSIONS: Survivors of sepsis hospitalization are at elevated risk of early and late post-discharge death as well as cardiovascular and non-cardiovascular rehospitalization. This hazard spans the spectrum of cardiovascular events and may suggest that sepsis is an important cardiovascular risk factor.
KW - heart failure
KW - mortality
KW - myocardial infarction
KW - sepsis
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U2 - 10.1161/JAHA.122.027813
DO - 10.1161/JAHA.122.027813
M3 - Article
C2 - 36722388
AN - SCOPUS:85147536700
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 3
M1 - e027813
ER -