Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals

Abstract

Importance Sepsis is present in many hospitalizations that culminate in death. The contribution of sepsis to these deaths, and the extent to which they are preventable, is unknown. Objective To estimate the prevalence, underlying causes, and preventability of sepsis-associated mortality in acute care hospitals. Design, Setting, and Participants Cohort study in which a retrospective medical record review was conducted of 568 randomly selected adults admitted to 6 US academic and community hospitals from January 1, 2014, to December 31, 2015, who died in the hospital or were discharged to hospice and not readmitted. Medical records were reviewed from January 1, 2017, to March 31, 2018. Main Outcomes and Measures Clinicians reviewed cases for sepsis during hospitalization using Sepsis-3 criteria, hospice-qualifying criteria on admission, immediate and underlying causes of death, and suboptimal sepsis-related care such as inappropriate or delayed antibiotics, inadequate source control, or other medical errors. The preventability of each sepsis-associated death was rated on a 6-point Likert scale. Results The study cohort included 568 patients (289 [50.9%] men; mean [SD] age, 70.5 [16.1] years) who died in the hospital or were discharged to hospice. Sepsis was present in 300 hospitalizations (52.8%; 95% CI, 48.6%-57.0%) and was the immediate cause of death in 198 cases (34.9%; 95% CI, 30.9%-38.9%). The next most common immediate causes of death were progressive cancer (92 [16.2%]) and heart failure (39 [6.9%]). The most common underlying causes of death in patients with sepsis were solid cancer (63 of 300 [21.0%]), chronic heart disease (46 of 300 [15.3%]), hematologic cancer (31 of 300 [10.3%]), dementia (29 of 300 [9.7%]), and chronic lung disease (27 of 300 [9.0%]). Hospice-qualifying conditions were present on admission in 121 of 300 sepsis-associated deaths (40.3%; 95% CI 34.7%-46.1%), most commonly end-stage cancer. Suboptimal care, most commonly delays in antibiotics, was identified in 68 of 300 sepsis-associated deaths (22.7%). However, only 11 sepsis-associated deaths (3.7%) were judged definitely or moderately likely preventable; another 25 sepsis-associated deaths (8.3%) were considered possibly preventable. Conclusions and Relevance In this cohort from 6 US hospitals, sepsis was the most common immediate cause of death. However, most underlying causes of death were related to severe chronic comorbidities and most sepsis-associated deaths were unlikely to be preventable through better hospital-based care. Further innovations in the prevention and care of underlying conditions may be necessary before a major reduction in sepsis-associated deaths can be achieved.

Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology

“…Indeed, WRF as the result of effective decongestion and/or implementation of disease‐modifying therapies like RAAS blockers do favourably affect outcome. However, at the same time, hospital admission can also be complicated with other co‐existing illnesses such as acute infections, sepsis, blood loss, which can also result in the occurrence of WRF, also typically later during the course of hospitalization . Similarly, exposure to nephrotoxic agents as iodine contrast, certain antibiotics or non‐steroidal anti‐inflammatory drugs (NSAIDs) during an AHF admission could also results in WRF.…”

Phenotypic heterogeneity by site of infection in surgical sepsis: a prospective longitudinal study

“…Despite decades of intensive research, sepsis remains a common deadly, costly, and debilitating intensive care unit (ICU) syndrome [1][2][3]. Traditionally, sepsis has been viewed to be due to an over-exuberant systemic inflammatory response syndrome (SIRS) that caused early deaths from refractory septic shock or unremitting multiple organ failure (MOF) [4][5][6].…”

Trends in sepsis mortality over time in randomised sepsis trials: a systematic literature review and meta-analysis of mortality in the control arm, 2002–2016

“…Sepsis is a potentially life-threatening condition which is estimated to affect over 30 million people worldwide each year [1]. Recent data suggest that sepsis contributes to between one third and half of all hospital deaths in the USA and accounts for a significant part of the overall costs of healthcare [2][3][4]. The incidence of severe sepsis and septic shock in developed countries has been reported as increasing steadily over recent decades; for example, during 2004-2009, the incidence of severe sepsis increased from 300 to 1031 cases per 100,000 population in the USA [5].…”