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Engoren M, Arslanian-Engoren C. Risk factors for readmission after sepsis and its association with mortality. Heart Lung 2024; 68:195-201. [PMID: 39032421 DOI: 10.1016/j.hrtlng.2024.07.007] [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: 04/23/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Sepsis is associated with an approximately 20 % 30-day readmission rate and with subsequent mortality. OBJECTIVES To determine the demographics, comorbidities that had been documented prior to sepsis onset, processes of care, commonly administered laboratory tests measured near discharge, and post-sepsis infections that may be associated with readmission and, secondarily, whether readmission is an independent risk factor for 90-day mortality. METHODS Using a database of patients who met Sepsis-3 criteria divided into Construction and Validation groups, we used logistic regression to estimate the factors independently associated with readmission within 30 days after discharge and proportional hazard regression to estimate the factors independently associated with 90-day mortality. RESULTS Of the 30,798 patients ≥ 18 years at our combined referral and community hospital and were discharged alive who met Sepsis-3 criteria between July 10, 2009 and September 7, 2019, 5943 (19 %) were readmitted within 30 days. Thirteen thousand, four hundred forty-four (44 %) of the patients were female, 25,293 (82 %) White, 3523 (11 %) Black, and the mean age was 59 ± 17 years. Among the readmitted patients, 894 (15 %) died within 90 days from the original discharge compared to 11 % (p < 0.001) who had not been readmitted. Seven comorbidities, five processes of care (presepsis platelet transfusion, postsepsis platelet transfusion, operation, ICU length of stay, and hospital length of stay), five culture results, two discharge laboratory values, and discharge location were associated with readmission. The model had good discrimination, 0.770 ± 0.004 (Construction Group) and 0.748 ± 0.006 (Validation Group) and good relevancy (area under the precision recall curve), 0.390 ± 0.004 (Construction group) and 0.476 ± 0.005 (Validation group). Readmission within 30 days was independently associated with a 56 % higher risk of death (HR=1.562, 95 % CI=1.434, 1.703, p < 0.001) within 90 days from discharge. CONCLUSIONS Comorbidities, abnormal laboratory values, processes of care, and post-sepsis onset culture results, but not demographic characteristics, were associated with 30-day readmission. Readmission was associated with 90-day mortality.
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Affiliation(s)
- Milo Engoren
- Department of Anesthesiology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, United States.
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Pandolfi F, Brun-Buisson C, Guillemot D, Watier L. One-year hospital readmission for recurrent sepsis: associated risk factors and impact on 1-year mortality-a French nationwide study. Crit Care 2022; 26:371. [PMID: 36447252 PMCID: PMC9710072 DOI: 10.1186/s13054-022-04212-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/15/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sepsis is a complex health condition, leading to long-term morbidity and mortality. Understanding the risk factors for recurrent sepsis, as well as its impact on mid- and long-term mortality among other risk factors, is essential to improve patient survival. METHODS A risk factor analysis, based on French nationwide medico-administrative data, was conducted on a cohort of patients above 15 years old, hospitalized with an incident sepsis in metropolitan France between 1st January 2018 and 31st December 2018 and who survived their index hospitalization. Two main analyses, focusing on outcomes occurring 1-year post-discharge, were conducted: a first one to assess risk factors for recurrent sepsis and a second to assess risk factors for mortality. RESULTS Of the 178017 patients surviving an incident sepsis episode in 2018 and included in this study, 22.3% died during the 1-year period from discharge and 73.8% had at least one hospital readmission in acute care, among which 18.1% were associated with recurrent sepsis. Patients aged between 56 and 75, patients with cancer and renal disease, with a long index hospital stay or with mediastinal or cardiac infection had the highest odds of recurrent sepsis. One-year mortality was higher for patients with hospital readmission for recurrent sepsis (aOR 2.93; 99% CI 2.78-3.09). Among all comorbidities, patients with cancer (aOR 4.35; 99% CI 4.19-4.52) and dementia (aOR 2.02; 99% CI 1.90-2.15) had the highest odds of 1-year mortality. CONCLUSION Hospital readmission for recurrent sepsis is one of the most important risk factors for 1-year mortality of septic patients, along with age and comorbidities. Our study suggests that recurrent sepsis, as well as modifiable or non-modifiable other risk factors identified, should be considered in order to improve patient care pathway and survival.
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Affiliation(s)
- Fanny Pandolfi
- grid.508487.60000 0004 7885 7602Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Université Paris Cité, Paris, France ,grid.12832.3a0000 0001 2323 0229Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint Quentin-en-Yvelines/Université Paris Saclay, Paris, France
| | - Christian Brun-Buisson
- grid.508487.60000 0004 7885 7602Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Université Paris Cité, Paris, France ,grid.12832.3a0000 0001 2323 0229Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint Quentin-en-Yvelines/Université Paris Saclay, Paris, France
| | - Didier Guillemot
- grid.508487.60000 0004 7885 7602Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Université Paris Cité, Paris, France ,grid.12832.3a0000 0001 2323 0229Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint Quentin-en-Yvelines/Université Paris Saclay, Paris, France ,grid.50550.350000 0001 2175 4109AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Laurence Watier
- grid.508487.60000 0004 7885 7602Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Université Paris Cité, Paris, France ,grid.12832.3a0000 0001 2323 0229Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint Quentin-en-Yvelines/Université Paris Saclay, Paris, France
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Inoue S, Nakanishi N, Sugiyama J, Moriyama N, Miyazaki Y, Sugimoto T, Fujinami Y, Ono Y, Kotani J. Prevalence and Long-Term Prognosis of Post-Intensive Care Syndrome after Sepsis: A Single-Center Prospective Observational Study. J Clin Med 2022; 11:5257. [PMID: 36142904 PMCID: PMC9505847 DOI: 10.3390/jcm11185257] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 01/08/2023] Open
Abstract
Post-intensive care syndrome (PICS) comprises physical, mental, and cognitive disorders following a severe illness. The impact of PICS on long-term prognosis has not been fully investigated. This study aimed to: (1) clarify the frequency and clinical characteristics of PICS in sepsis patients and (2) explore the relationship between PICS occurrence and 2-year survival. Patients with sepsis admitted to intensive care unit were enrolled. Data on patient background; clinical information since admission; physical, mental, and cognitive impairments at 3-, 6-, and 12-months post-sepsis onset; 2-year survival; and cause of death were obtained from electronic medical records and telephonic interviews with patients and their families. At 3 months, comparisons of variables were undertaken in the PICS group and the non-PICS group. Among the 77 participants, the in-hospital mortality rate was 11% and the 2-year mortality rate was 52%. The frequencies of PICS at 3, 6, and 12 months were 70%, 60%, and 35%, respectively. The 2-year survival was lower in the PICS group than in the non-PICS group (54% vs. 94%, p < 0.01). More than half of the survivors had PICS at 3 and 6 months after sepsis. Among survivors with sepsis, those who developed PICS after 3 months had a lower 2-year survival.
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Affiliation(s)
- Shigeaki Inoue
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Nobuto Nakanishi
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Jun Sugiyama
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Naoki Moriyama
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Yusuke Miyazaki
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Takashi Sugimoto
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Chuo Hospital, Honmachi 439, Kakogawa 675-8611, Japan
| | - Yuko Ono
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
| | - Joji Kotani
- Department of Disaster and Emergency and Critical Care Medicine, Kobe University Graduate School of Medicine, Kusunoki-Cho 7-5-2, Chuo-Ward, Kobe 650-0017, Japan
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Sepsis-Associated Mortality, Resource Use, and Healthcare Costs: A Propensity-Matched Cohort Study. Crit Care Med 2021; 49:215-227. [PMID: 33372748 DOI: 10.1097/ccm.0000000000004777] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To examine long-term mortality, resource utilization, and healthcare costs in sepsis patients compared to hospitalized nonsepsis controls. DESIGN Propensity-matched population-based cohort study using administrative data. SETTING Ontario, Canada. PATIENTS We identified a cohort of adults (≥ 18) admitted to hospitals in Ontario between April 1, 2012, and March 31, 2016, with follow-up to March 31, 2017. Sepsis patients were flagged using a validated International Classification of Diseases, 10th Revision-coded algorithm (Sepsis-2 definition), including cases with organ dysfunction (severe sepsis) and without (nonsevere). Remaining hospitalized patients were potential controls. Cases and controls were matched 1:1 on propensity score, age, sex, admission type, and admission date. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Differences in mortality, rehospitalization, hospital length of stay, and healthcare costs were estimated, adjusting for remaining confounders using Cox regression and generalized estimating equations. Of 270,669 sepsis cases, 196,922 (73%) were successfully matched: 64,204 had severe and 132,718 nonsevere sepsis (infection without organ dysfunction). Over follow-up (median 2.0 yr), severe sepsis patients had higher mortality rates than controls (hazard ratio, 1.66; 95% CI, 1.63-1.68). Both severe and nonsevere sepsis patients had higher rehospitalization rates than controls (hazard ratio, 1.53; 95% CI, 1.50-1.55 and hazard ratio, 1.41; 95% CI, 1.40-1.43, respectively). Incremental costs (Canadian dollar 2018) in sepsis cases versus controls at 1-year were: $29,238 (95% CI, $28,568-$29,913) for severe and $9,475 (95% CI, $9,150-$9,727) for nonsevere sepsis. CONCLUSIONS Severe sepsis was associated with substantially higher long-term risk of death, rehospitalization, and healthcare costs, highlighting the need for effective postdischarge care for sepsis survivors.
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Bae HJ, Kim JS, Kim M, Kim YJ, Kim WY. Prognostic Value of the Time-to-Positivity in Blood Cultures from Septic Shock Patients with Bacteremia Receiving Protocol-Driven Resuscitation Bundle Therapy: A Retrospective Cohort Study. Antibiotics (Basel) 2021; 10:antibiotics10060683. [PMID: 34201159 PMCID: PMC8228862 DOI: 10.3390/antibiotics10060683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction: To evaluate the prognostic value of the time-to-positivity in patients with culture-positive septic shock. Methods: Retrospective study using a prospective data registry was performed at the emergency department of a tertiary hospital. Consecutive adult patients with septic shock (N = 2499) were enrolled between 2014 and 2018. Bacteremia was defined using blood cultures, and viral and fungal pathogens were excluded. The primary outcome was the 28-day mortality. Results: In 803 (46.7%) septic shock patients with bacteremia, median TTP was 10.1 h. The most prevalent isolated bacterial pathogens were Escherichia coli (40.8%) and Klebsiella (23.4%). Although the TTP correlated with a higher sequential organ failure assessment score (Spearman’s rho = −0.12, p < 0.01), it showed no significant difference between the 28-day survivors and non-survivors (10.2 vs. 9.4 days, p = 0.35). In subgroup analysis of the Escherichia coli and Klebsiella bacteremia cases, a shorter TTP showed prognostic value for predicting the 28-day mortality. The optimal TTP cut-off for Escherichia coli and Klebsiella was 10 h and 8 h, respectively. Conclusions: The prognostic value of the TTP in septic shock patients receiving bundle therapy may be limited and its clinical interpretation should only be made on a pathogen-specific basis.
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Affiliation(s)
| | | | | | | | - Won Young Kim
- Correspondence: ; Tel.: +82-2-3010-3350; Fax: +82-2-3010-3360
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Kim JS, Kim YJ, Kim WY. Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:11. [PMID: 33407768 PMCID: PMC7787242 DOI: 10.1186/s13054-020-03421-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/02/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND We evaluated the characteristics and outcomes of culture-negative versus culture-positive septic shock. METHODS We performed a retrospective observational study of data from a prospective registry from 2014 to 2018. A total of 2,499 adult patients with septic shock were enrolled. The primary outcome was 90-day mortality, and the secondary outcomes were the length of hospital stay, a requirement for mechanical ventilation or renal replacement therapy, and in-hospital mortality. RESULTS Of 1,718 patients with septic shock, 1,012 (58.9%) patients were culture-positive (blood 803, urine 302, sputum 102, others 204) and the median pathogen detection time was 9.5 h (aerobic 10.2 h and anaerobic 9.0 h). The most common site of culture-positive infection was the hepatobiliary tract (39.5%), while for the culture-negative it was the lower respiratory tract (38.2%). The culture-negative group had a lower mean body temperature (37.3 vs 37.7 ℃), lactate (2.5 vs. 3.2 mmol/L), C-reactive protein (11.1 vs 11.9 mg/dL), and sequential organ failure assessment score (7.0 vs. 8.0) than that of the culture-positive group. However, 90-day mortality between the groups was not significantly different (32.7 vs 32.2%, p = 0.83), and the other clinical outcomes also did not differ significantly. Moreover, a shorter culture detection time was correlated with a higher sequential organ failure assessment score but not with mortality. CONCLUSION Patients with septic shock are frequently culture-negative, especially in cases where the infection focus is in the lower respiratory tract. Although culture-negative was associated with a degree of organ dysfunction, it was not an independent predictor of death.
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Affiliation(s)
- June-Sung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil., Songpa-gu, Seoul, 05505, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil., Songpa-gu, Seoul, 05505, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil., Songpa-gu, Seoul, 05505, Korea.
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Kim JS, Kim YJ, Kim M, Ryoo SM, Kim WY. Association between right ventricle dysfunction and poor outcome in patients with septic shock. Heart 2020; 106:1665-1671. [PMID: 32641318 DOI: 10.1136/heartjnl-2020-316889] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Sepsis-induced myocardial dysfunction (SIMD) can involve both the left and right ventricles. However, the characteristics and outcomes across various manifestations of SIMD remain unknown. METHODS This was a retrospective cohort study using a prospective registry of septic shock from January 2011 and April 2017. Patients with clinically presumed cardiac dysfunction underwent echocardiography within 72 hours after admission and were enrolled (n=778). SIMD was classified as left ventricle (LV) systolic/diastolic and right ventricle (RV) dysfunction, which were defined based on the American Society of Echocardiography criteria. The primary outcome was 28-day mortality. RESULTS Of the 778 septic shock patients who underwent echocardiography, 270 (34.7%) showed SIMD. The median age was 67.0 years old, and the male was predominant (57.3%). Among them, 67.3% had LV systolic dysfunction, 40.7% had RV dysfunction and 39.3% had LV diastolic dysfunction. Although serum lactate level and sequential organ failure assessment score were not significantly different between groups, SIMD group showed higher troponin I (0.1 vs 0.1 ng/mL; p=0.02) and poor clinical outcomes, including higher 28-day mortality (35.9 vs 26.8%; p<0.01), longer intensive care unit length of stay (5 vs 2 days; p<0.01) and prolonged mechanical ventilation (9 vs 4 days; p<0.01). Multivariate analysis showed that isolated RV dysfunction was an independent risk factor of 28-day mortality (OR 2.26, 95% CI 1.04 to 4.91). CONCLUSIONS One-third of patients with septic shock showed various myocardial dysfunctions. LV systolic dysfunction was common; however, only RV dysfunction was associated with short-term mortality.
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Affiliation(s)
- June-Sung Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Muyeol Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
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Yang WS, Kang HD, Jung SK, Lee YJ, Oh SH, Kim YJ, Sohn CH, Kim WY. A mortality analysis of septic shock, vasoplegic shock and cryptic shock classified by the third international consensus definitions (Sepsis-3). CLINICAL RESPIRATORY JOURNAL 2020; 14:857-863. [PMID: 32438528 DOI: 10.1111/crj.13218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/10/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study aimed to compare the 28-day mortality of patients with septic shock, defined by Sepsis-3 criteria and patients with vasoplegic or cryptic shock who are excluded from this new definition. OBJECTIVES This retrospective observational study was performed using a tertiary emergency department's septic shock registry and investigated the records of patients managed between January 2010 and December 2015. In 2,138 total patients, 1004 (47.0%) had septic shock, 476 (22.2%) had vasoplegic shock and 655 (30.6%) had cryptic shock. RESULTS There was significant variation in 28-day mortality among the three groups: 23.4% for septic shock, 8.8% for vasoplegic shock and 12.2% for cryptic shock (P < .001). In subgroup analysis of cryptic shock or septic shock according to lactate levels (2-3, 3-4 and >4 mmol/L), the mortality rate increased as lactate increased (cryptic shock: 9.5%, 14.8% and 18.0%; septic shock: 18.6%, 22.6% and 27.0%, respectively; P < .001). Multivariable analysis revealed odds ratios for mortality of 0.31 (95% CI 0.22-0.44; P < .001) for vasoplegic shock and 0.46 (95% CI 0.35-0.61; P < .001) for cryptic shock relative to septic shock. Survival curve analysis showed significant differences among patients with septic shock, vasoplegic shock and cryptic shock (Log rank test: P < .0001). CONCLUSION The new septic shock definition may be useful for identifying high-risk patients requiring intensive care. However, cryptic shock-associated mortality increased to 18.0% as serum lactate increased, which suggests that some cryptic shock patients may also require intensive management.
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Affiliation(s)
- Won S Yang
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hui D Kang
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang K Jung
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - You J Lee
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Se H Oh
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang H Sohn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Y Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shankar-Hari M, Saha R, Wilson J, Prescott HC, Harrison D, Rowan K, Rubenfeld GD, Adhikari NKJ. Rate and risk factors for rehospitalisation in sepsis survivors: systematic review and meta-analysis. Intensive Care Med 2020; 46:619-636. [PMID: 31974919 PMCID: PMC7222906 DOI: 10.1007/s00134-019-05908-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/19/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Sepsis survivors have a higher risk of rehospitalisation and of long-term mortality. We assessed the rate, diagnosis, and independent predictors for rehospitalisation in adult sepsis survivors. METHODS We searched for non-randomized studies and randomized clinical trials in MEDLINE, Cochrane Library, Web of Science, and EMBASE (OVID interface, 1992-October 2019). The search strategy used controlled vocabulary terms and text words for sepsis and hospital readmission, limited to humans, and English language. Two authors independently selected studies and extracted data using predefined criteria and data extraction forms. RESULTS The literature search identified 12,544 records. Among 56 studies (36 full and 20 conference abstracts) that met our inclusion criteria, all were non-randomised studies. Studies most often report 30-day rehospitalisation rate (mean 21.4%, 95% confidence interval [CI] 17.6-25.4%; N = 36 studies reporting 6,729,617 patients). The mean (95%CI) rehospitalisation rates increased from 9.3% (8.3-10.3%) by 7 days to 39.0% (22.0-59.4%) by 365 days. Infection was the most common rehospitalisation diagnosis. Risk factors that increased the rehospitalisation risk in sepsis survivors were generic characteristics such as older age, male, comorbidities, non-elective admissions, hospitalisation prior to index sepsis admission, and sepsis characteristics such as infection and illness severity, with hospital characteristics showing inconsistent associations. The overall certainty of evidence was moderate for rehospitalisation rates and low for risk factors. CONCLUSIONS Rehospitalisation events are common in sepsis survivors, with one in five rehospitalisation events occurring within 30 days of hospital discharge following an index sepsis admission. The generic and sepsis-specific characteristics at index sepsis admission are commonly reported risk factors for rehospitalisation. REGISTRATION PROSPERO CRD 42016039257, registered on 14-06-2016.
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Affiliation(s)
- Manu Shankar-Hari
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, 1st Floor, East Wing, St Thomas' Hospital, SE1 7EH, UK.
- School of Immunology and Microbial Sciences, Kings College London, London, SE1 9RT, UK.
- Intensive Care National Audit and Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK.
| | - Rohit Saha
- School of Immunology and Microbial Sciences, Kings College London, London, SE1 9RT, UK
| | - Julie Wilson
- Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, 1st Floor, East Wing, St Thomas' Hospital, SE1 7EH, UK
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Ann Arbor, MI, 48109-2800, USA
- VA Center for Clinical Management Research, University of Michigan Health System, Ann Arbor, MI, USA
| | - David Harrison
- Intensive Care National Audit and Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Kathryn Rowan
- Intensive Care National Audit and Research Centre, Napier House, 24 High Holborn, London, WC1V 6AZ, UK
| | - Gordon D Rubenfeld
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, M4N 3M5, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, D1.08, Toronto, ON, M4N 3M5, Canada
| | - Neill K J Adhikari
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, M4N 3M5, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, D1.08, Toronto, ON, M4N 3M5, Canada
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Ko DR, Kong T, Lee HS, Kim S, Lee JW, Chung HS, Chung SP, You JS, Park JW. Usefulness of the Thrombotic Microangiopathy Score as a Promising Prognostic Marker of Septic Shock for Patients in the Emergency Department. J Clin Med 2019; 8:jcm8060808. [PMID: 31174267 PMCID: PMC6617054 DOI: 10.3390/jcm8060808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 01/20/2023] Open
Abstract
The thrombotic microangiopathy (TMA) score based on the development and morphological characteristics of schistocytes is a rapid, simple biomarker that is easily obtained from the complete blood cell count by an automated blood cell analyzer. We aimed to determine whether the TMA score is associated with 30-day mortality of patients with early-stage septic shock. This observational cohort study was retrospectively conducted based on a prospective emergency department (ED) registry (June 2015–December 2016). We analyzed the TMA score at ED admission and 24 h later. The primary endpoint was all-cause mortality within 30 days of ED admission. A total of 221 patients were included. Increased TMA scores at time 0 (odds ratio (OR), 1.972; 95% confidence interval (CI), 1.253–3.106; p = 0.003) and at time 24 (OR, 1.863; 95% CI, 1.863–3.066; p = 0.014) were strong predictors of 30-day mortality. Increased predictability of 30-day mortality was closely associated with TMA scores ≥2 at time 0 (OR, 4.035; 95% CI, 1.651–9.863; p = 0.002) and ≥3 at time 24 (OR, 5.639; 95% CI, 2.190–14.519; p < 0.001). Increased TMA scores significantly predicted 30-day mortality for patients with severe sepsis and septic shock and can be helpful when determining the initial treatment strategies without additional costs or effort.
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Affiliation(s)
- Dong Ryul Ko
- Department of Emergency Medicine, Yonsei University College of Medicine, 06273 Seoul, Korea.
- Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, 24289 Chuncheon, Korea.
| | - Taeyoung Kong
- Department of Emergency Medicine, Yonsei University College of Medicine, 06273 Seoul, Korea.
- Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, 24289 Chuncheon, Korea.
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, 06273 Seoul, Korea.
| | - Sinae Kim
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, 06273 Seoul, Korea.
| | - Jong Wook Lee
- Department of Laboratory Medicine, Konyang University Hospital, 35365 Daejon, Korea.
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 06273 Seoul, Korea.
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 06273 Seoul, Korea.
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, 06273 Seoul, Korea.
| | - Jong Woo Park
- Department of Emergency Medicine, Good Sunlin Hospital, 37725 Pohang, Korea.
- Department of Emergency Medicine, Graduate School of medicine, Kosin University, 49267 Busan, Korea.
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