Epidemiology of Hospital-Onset versus Community-Onset Sepsis in U.S. Hospitals and Association with Mortality: A Retrospective Analysis Using Electronic Clinical Data

Details

• Alternative Title:
  Crit Care Med
• Personal Author:
  Rhee, Chanu ; Wang, Rui ; Zhang, Zilu ; Fram, David ; Kadri, Sameer S. ; Klompas, Michael
• Description:
  Objectives
  
  Prior studies have reported that hospital-onset (HO)-sepsis is associated with higher mortality rates than community-onset (CO)-sepsis. Most studies, however, have used inconsistent case-finding methods and applied limited risk-adjustment for potential confounders. We used consistent sepsis criteria and detailed electronic clinical data to elucidate the epidemiology and mortality associated with HO-sepsis.
  
  Design
  
  Retrospective cohort study
  
  Setting
  
  136 U.S. hospitals in the Cerner HealthFacts dataset
  
  Patients
  
  Adults hospitalized in 2009–2015
  
  Interventions
  
  None
  
  Measurements and Main Results
  
  We identified sepsis using CDC Adult Sepsis Event criteria and estimated the risk of in-hospital death for HO-sepsis versus CO-sepsis using logistic regression models. In patients admitted without CO-sepsis, we estimated risk of death associated with HO-sepsis using Cox regression models with sepsis as a time-varying covariate. Models were adjusted for baseline characteristics and severity-of-illness. Among 2.2 million hospitalizations, there were 95,154 sepsis cases: 83,620 (87.9%) CO-sepsis and 11,534 (12.1%) HO-sepsis (0.5% of hospitalized cohort). Compared to CO-sepsis, HO-sepsis patients were younger (median 66 vs 68 years) but had more comorbidities (median Elixhauser score 14 vs 11), higher Sequential Organ Failure Assessment scores (median 4 vs 3), higher ICU admission rates (61% vs 44%), longer hospital length-of-stay (median 19 vs 8 days), and higher in-hospital mortality (33% vs 17%) (p<0.001 for all comparisons). On multivariate analysis, HO-sepsis was associated with higher mortality versus CO-sepsis (odds ratio 2.1, 95% CI 2.0–2.2) and patients admitted without sepsis (hazard ratio 3.0, 95% CI 2.9–3.2).
  
  Conclusions
  
  HO-sepsis complicated 1 in 200 hospitalizations and accounted for 1 in 8 sepsis cases, with 1 in 3 patients dying in-hospital. HO-sepsis preferentially afflicted ill patients but even after risk-adjustment they were twice as likely to die as CO-sepsis patients; in patients admitted without sepsis, HO-sepsis tripled the risk of death. HO-sepsis is an important target for surveillance, prevention, and quality improvement initiatives.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Age Distribution Article Community-Acquired Infections Comorbidity Cross Infection Female Hospital Mortality Humans Intensive Care Units Length Of Stay Logistic Models Male Middle Aged Organ Dysfunction Scores Proportional Hazards Models Retrospective Studies Sepsis Severity Of Illness Index

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• Source:
  Crit Care Med. 47(9):1169-1176
• Pubmed ID:
  31135503
• Pubmed Central ID:
  PMC6697188
• Document Type:
  Journal Article
• Funding:
  K08 HS025008/HS/AHRQ HHS/United States ; U54 CK000484/CK/NCEZID CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  47
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:71d5d38190a94d47e211b5463358384b93b19270bf1bcfcfac0d3e626e81fda5
• Download URL:
  https://stacks.cdc.gov/view/cdc/80738/cdc_80738_DS1.pdf
• File Type:
  [PDF - 389.21 KB ]