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Prevalence and Outcomes of Previously Healthy Adults Among Patients Hospitalized with Community-Onset Sepsis
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7 2022
Source: Chest. 162(1):101-110 -
Alternative Title:Chest
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Description:Background:
Devastating cases of sepsis in previously healthy patients have received widespread attention and helped catalyze state and national mandates to improve sepsis detection and care. It is unclear, however, what proportion of patients hospitalized with sepsis were previously healthy and how their outcomes compare to patients with comorbidities.
Research Question:
Among adults hospitalized with community-onset sepsis, how many are previously healthy and how do their outcomes compare to those with comorbidities?
Study Design and Methods:
We retrospectively identified all adults with community-onset sepsis hospitalized in 373 U.S. hospitals from 2009–2015 using clinical indicators of presumed infection and organ dysfunction (CDC’s Adult Sepsis Event criteria). Comorbidities were identified using ICD-9-CM 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%) had community-onset sepsis. Most sepsis patients (329,052; 97.4%) had at least one comorbidity; only 2.6% were previously healthy. Patients with sepsis who were previously healthy were younger than those with comorbidities (mean 58.0 ± 19.8 vs 67.0 ± 16.5 years), less likely to require ICU care on admission (37.9% vs 50.5%), and more likely to be discharged home (57.9% vs 45.6%) rather than to subacute facilities (16.3% vs 30.8%) but had 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 have pre-existing comorbidities. However, previously healthy patients may be more likely to die when they present to the hospital with sepsis compared to patients with comorbidities. These findings underscore the importance of early sepsis recognition and treatment for all patients.
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Pubmed ID:35065940
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Pubmed Central ID:PMC9271603
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