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Chang J, Medina M, Kim SJ. Is patients' rurality associated with in-hospital sepsis death in US hospitals? Front Public Health 2023; 11:1169209. [PMID: 37383255 PMCID: PMC10294422 DOI: 10.3389/fpubh.2023.1169209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Background The focus of this study was to explore the association of patients' rurality and other patient and hospital-related factors with in-hospital sepsis mortality to identify possible health disparities across United States hospitals. Methods The National Inpatient Sample was used to identify nationwide sepsis patients (n = 1,977,537, weighted n = 9,887,682) from 2016 to 2019. We used multivariate survey logistic regression models to identify predictors for how patients' rurality is associated with in-hospital death. Findings During the study periods, in-hospital death rates among sepsis inpatients continuously decreased (11.3% in 2016 to 9.9% in 2019) for all rurality levels. Rao-Schott Chi-Square tests demonstrated that certain patient and hospital factors had varied in-hospital death rates. Multivariate survey logistic regressions suggested that rural areas, minorities, females, older adults, low-income, and uninsured patients have higher odds of in-hospital mortality. Further, specific census divisions like New England, Middle Atlantic, and East North Central had greater in-hospital sepsis death odds. Conclusion Rurality was associated with increased in-hospital sepsis death across multiple patient populations and locations. Further, rurality in New England, Middle Atlantic, and East North Central locations is exceptionally high odds. In addition, minority races in rural areas also have an increased odds of in-hospital death. Therefore, rural healthcare requires a more significant influx of resources and should also include assessing patient-related factors.
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Affiliation(s)
- Jongwha Chang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel School of Pharmacy, Texas A&M University, College Station, TX, United States
| | - Mar Medina
- School of Pharmacy, University of Texas at El Paso, El Paso, TX, United States
| | - Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
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Zhu Y, Zhang R, Ye X, Liu H, Wei J. SAPS III is superior to SOFA for predicting 28-day mortality in sepsis patients based on Sepsis 3.0 criteria. Int J Infect Dis 2022; 114:135-141. [PMID: 34775116 DOI: 10.1016/j.ijid.2021.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The discrimination and calibration accuracy of prediction models tends to become poor over time. The performance of predictive models should be reevaluated periodically. The aim of this study was to reassess the discrimination of the six commonly used models for predicting 28-day mortality in patients with sepsis based on the Sepsis 3.0 criteria. METHODS Patient data were extracted from the fourth edition of the Medical Information Mart for Critical Care (MIMIC IV) database. The systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Oxford Acute Severity of Illness Score (OASIS), Logistic Organ Dysfunction System (LODS), and Simplified Acute Physiology Score II (SAPS II) and III (SAPS III) scores were calculated and collected. The area under the receiver operating characteristic curve (AUROC) was used to compare the discrimination abilities of the models using non-parametric Wilcoxon statistics. The Delong method was used to perform pairwise comparisons of the AUROCs of the models. Multiple subgroup analyses for age, body mass index, and sex were performed with regard to the 28-day mortality prediction of the models. RESULTS A total of 12 691 patients were included. The mean age of the patients was 65.97 ± 15.77 years; 7673 patients (60.50%) were male. The mean SIRS, SOFA, OASIS, SAPS II, LODS, and SAPS III scores were higher in the non-survivor group than in the survivor group. The discrimination for 28-day mortality with the SAPS III (AUROC 0.812, 95% confidence interval (CI) 0.802-0.822) and LODS (AUROC 0.804, 95% CI 0.743-0.765) models was superior to that of the SIRS (AUROC 0.575, 95% CI 0.562-0.589), SOFA (AUROC 0.612, 95% CI 0.598-0.626), OASIS (AUROC 0.753, 95% CI 0.742-0.764), and SAPS II (AUROC 0.754, 95% CI 0.743-0.765) models. The Youden index of the SAPS III model was 0.484, which was the highest among the models. Subgroup analyses showed similar results to the overall results. CONCLUSIONS The discrimination for 28-day mortality with the SAPS III and LODS models was superior to that of the SIRS, SOFA, OASIS, and SAPS II models. The SAPS III model showed the best discrimination capacity for 28-day mortality compared with the other models.
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Affiliation(s)
- Youfeng Zhu
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou 510220, Guangdong Province, China.
| | - Rui Zhang
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou 510220, Guangdong Province, China.
| | - Xiaoling Ye
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou 510220, Guangdong Province, China.
| | - Houqiang Liu
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou 510220, Guangdong Province, China.
| | - Jianrui Wei
- Guangzhou Women and Children's Medical Center, Guangzhou 510220, Guangdong Province, China.
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Zhu Y, Yin H, Zhang R, Ye X, Wei J. The effect of dobutamine in sepsis: a propensity score matched analysis. BMC Infect Dis 2021; 21:1151. [PMID: 34758739 PMCID: PMC8582172 DOI: 10.1186/s12879-021-06852-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The use of dobutamine in patients with sepsis is questionable currently. As the benefit of dobutamine in septic patients is unclear, we aimed to evaluate whether the use of dobutamine was associated with decreased hospital mortality in sepsis patients. METHODS Based on the analysis of MIMIC III public database, we performed a big-data, real world study. According to the use of dobutamine or not, patients were categorized as the dobutamine group or non dobutamine group.We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. RESULTS In the present study, after screening 38,605 patients, 2826 patients with sepsis were included. 121 patients were in dobutamine group and 2165 patients were in non dobutamine group. Compared with patients in non-dobutamine group, patients in dobutamine group had a lower MAP, higher HR, higher RR, higher severity of illness scores. 72 of 121 patients (59.5%) in the dobutamine group and 754 of 2165 patients (34.8%) in the non-dobutamine group died in the hospital, which resulted in a significant between-group difference (OR 1.56, 95% CI 1.01-2.40; P = 0.000). For the secondary outcomes, patients in dobutamine group received more MV use, more renal replacement therapy use, had longer ICU stay durations and more cardiac arrhythmias than those in non-dobutamine group. After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistently higher in dobutamine group than that in non-dobutamine group (60.2% vs. 49.4%, OR 1.55, 95% CI 1.01-2.37; P = 0.044). CONCLUSIONS Among patients with sepsis, our study showed that the use of dobutamine was not associated with decreased hospital mortality. Further large scale, randomized controlled studies are warrented to confirm our findings.
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Affiliation(s)
- Youfeng Zhu
- grid.258164.c0000 0004 1790 3548Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangdong 510220 Guangzhou, China
| | - Haiyan Yin
- grid.412601.00000 0004 1760 3828Department of Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, 510220 Guangdong China
| | - Rui Zhang
- grid.258164.c0000 0004 1790 3548Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangdong 510220 Guangzhou, China
| | - Xiaoling Ye
- grid.258164.c0000 0004 1790 3548Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangdong 510220 Guangzhou, China
| | - Jianrui Wei
- grid.413428.80000 0004 1757 8466Guangzhou Women and Children’s Medical Center, No. 9 Jinsui Road, Guangzhou, 510220 Guangdong China
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Liang YW, Zhu YF, Zhang R, Zhang M, Ye XL, Wei JR. Incidence, prognosis, and risk factors of sepsis-induced cardiomyopathy. World J Clin Cases 2021; 9:9452-9468. [PMID: 34877280 PMCID: PMC8610866 DOI: 10.12998/wjcc.v9.i31.9452] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/20/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND At present, large-scale studies on the clinical characteristics of sepsis-induced cardiomyopathy (SIC) are lacking.
AIM To investigate the clinical characteristics of SIC.
METHODS Based on the analysis of the MIMIC-III public database, we performed a large-scale retrospective study involving sepsis patients who were admitted to the intensive care unit (ICU) and had no concomitant cardiac disease. We used propensity score matching analysis and multivariate logistic regression to ensure the robustness of the results. The primary outcome was hospital mortality, and the secondary outcomes included the number of patients who received mechanical ventilation or renal replacement therapy during their hospital stay, the number of patients administered with vasopressors, the length of ICU stay, and the length of hospital stay.
RESULTS In the present study, after screening 38605 patients, 3530 patients with sepsis were included. A total of 997 patients met the SIC diagnostic criteria, and the incidence of SIC was 28.20% (95% confidence interval [CI]: 26.80%-29.70%). Compared to patients in the non-SIC group, patients in the SIC group were of older age and had a higher Simplified Acute Physiology Score (SAPS)-I score, SAPS-II score, and Elixhauser comorbidity index (ECI). A total of 367 (36.8%) of 997 patients in the SIC group and 818 (32.3%) of 2533 patients in the non-SIC group died in the hospital, which resulted in a significant between-group difference (odds ratios = 1.22, 95%CI: 1.05-1.42; P = 0.011). For the secondary outcomes, more patients in the SIC group received mechanical ventilation and vasopressors. Multivariate logistic regression analysis showed that age, male sex, ECI, hemoglobin level, diabetes, and mechanical ventilation use on the first day of ICU admission were risk factors for SIC.
CONCLUSION Compared with non-SIC patients, hospital mortality is higher in SIC patients.
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Affiliation(s)
- Yan-Wen Liang
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Guangzhou 510220, Guangdong Province, China
| | - You-Feng Zhu
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Guangzhou 510220, Guangdong Province, China
| | - Rui Zhang
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Guangzhou 510220, Guangdong Province, China
| | - Min Zhang
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao 270000, Shandong Province, China
| | - Xiao-Ling Ye
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Guangzhou 510220, Guangdong Province, China
| | - Jian-Rui Wei
- Guangzhou Women and Children’s Medical Center, Guangzhou 510000, Guangdong Province, China
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Zhu Y, Yin H, Zhang R, Ye X, Wei J. The effect of dobutamine vs milrinone in sepsis: A big data, real-world study. Int J Clin Pract 2021; 75:e14689. [PMID: 34331721 DOI: 10.1111/ijcp.14689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/10/2021] [Accepted: 07/27/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The use of dobutamine in patients with sepsis is questionable. Some studies reported milrinone was used as an alternative inotropic agent. We aim to evaluate whether milrinone is better than dobutamine in patients with sepsis. METHODS Based on the analysis of MIMIC III public database, we performed a big data, real-world study. According to the use of dobutamine or milrinone, patients were categorised as the dobutamine group or milrinone group. We used propensity score matched (PSM) analysis to adjust for confoundings. The primary outcome was hospital mortality. RESULTS In this study, after screening 38 605 patients, 235 patients with sepsis were included. One hundred and eighty-three patients were in the dobutamine group and 52 patients were in the milrinone group. For the primary outcome of hospital mortality, there was no significant between-group difference (73/183 in dobutamine group vs 23/52 in milrinone group, OR 0.84, 95% CI 0.45-1.56; P = .574). After adjusting for confoundings between groups by PSM analysis, hospital mortality was consistent with the overall result (50% vs 41.3%, OR 1.42, 95% CI 0.68-2.97; P = .349). For the secondary outcomes, more patients in milrinone group received RRT use (46.2% vs 22.4%, P = .001), had longer length of ICU stay (20.97 ± 22.84 days vs 11.10 ± 11.54 days, P = .004) and hospital stay (26.14 ± 25.13 days vs 14.51 ± 13.11 days, P = .002) than those in dobutamine group. CONCLUSIONS Compared with dobutamine, the use of milrinone did not decrease hospital mortality in patients with sepsis. Furthermore, milrinone was associated with more RRT therapy, longer length of ICU stay and hospital stay than dobutamine.
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Affiliation(s)
- Youfeng Zhu
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Haiyan Yin
- Department of Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rui Zhang
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Xiaoling Ye
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jianrui Wei
- Guangzhou Women and Children's Medical Center, Guangzhou, China
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Indwelling medical device use and sepsis risk at a health professional shortage area hospital: Possible interaction with length of hospitalization. Am J Infect Control 2020; 48:1189-1194. [PMID: 32265075 DOI: 10.1016/j.ajic.2020.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND We aimed to identify risk factors for sepsis diagnosis and possible interaction with length of hospital stay (LOS) among inpatients at a rural Health Professional Shortage Area hospital. METHODS This case-control study examined 600 adult patients (300 cases and 300 controls) admitted to a rural health system in North Carolina between 2012 and 2018. Case selection was based on assignment of ICD-9-CM diagnostic codes for sepsis. Controls were patients with a medical diagnosis other than sepsis during the observational period. Logistic regression was used to model sepsis diagnosis as a function of indwelling medical device use and stratified by LOS. RESULTS Indwelling medical device use preadmission and postadmission were significantly associated with increased risk of sepsis diagnosis among patients with extended hospital stays (LOS ≥ 5 days) (odds ratio [OR] = 5.51; 95% confidence interval [CI] = 1.95-15.62; P = .001 and OR = 3.28; 95% CI = 1.24-8.68; P = .017, respectively). Among patients with LOS <5 days, association with sepsis diagnosis was only significant for indwelling medical device use preadmission (OR = 9.61; 95% CI = 3.68-25.08; P < .0001). CONCLUSIONS Indwelling medical device use was significantly associated with increased risk of sepsis diagnosis and the risk was higher with longer hospitalization.
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Zhou X, Wu F. It is SOFA score rather than quick SOFA (qSOFA) score that constitutes the clinical criteria of sepsis. Am J Infect Control 2018; 46:1315. [PMID: 30174257 DOI: 10.1016/j.ajic.2018.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 06/17/2018] [Indexed: 11/25/2022]
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Ahiawodzi PD, Kelly K, Thompson DK. Regarding "It is SOFA score rather than quick SOFA (qSOFA) score that constitutes the clinical criteria of sepsis". Am J Infect Control 2018; 46:1316-1317. [PMID: 30170766 DOI: 10.1016/j.ajic.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Peter D Ahiawodzi
- Department of Public Health, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina
| | - Kimberly Kelly
- Department of Pharmacy Practice, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina
| | - Dorothea K Thompson
- Department of Pharmaceutical Sciences, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina.
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