Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database-the Japan Sepsis Alliance (JaSA) study group-

Imaeda, Taro; Nakada, Taka‐aki; Takahashi, Nozomi; Yamao, Yasuo; Nakagawa, Satoshi; Ogura, Hiroshi; Shime, Nobuaki; Umemura, Yutaka; Matsushima, Asako; Fushimi, Kiyohide

doi:10.1186/s13054-021-03762-8

Cited by 38 publications

(51 citation statements)

References 36 publications

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“…However, changes in coding practices might have increased explicit sepsis due to the inclusion of less severe sepsis cases in this category, making the decline of mortality artificial 19 42. In-hospital mortality rate was around 25% and was comparable with the results obtained in previous studies where sepsis-related death rates ranged from 15% to 30%2 23 30 34 41 43 and confirms the high mortality risk associated with sepsis, although in-hospital mortality was lower than the 34% rate reported in the 2010–2015 study of Dupuis et al 13. Sepsis-related deaths also occurred outside of the hospital 44.…”

Section: Discussionsupporting

confidence: 80%

“…The median length of stays was 12 days in 2019, which is much higher than the usual length of stay in acute care units. Comparatively to previous studies, in-hospital mortality slightly declined over time 16 41. Moreover, the concomitant increase of explicit sepsis, which could be considered as the most severe sepsis cases, could suggest a real decline in mortality rate.…”

Section: Discussioncontrasting

confidence: 56%

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Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

et al. 2022

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ObjectiveThis study aims to provide a case definition of sepsis of presumed bacterial aetiology based on 10th revision of the International Classification of Diseases (ICD-10) codes, to assess trends in sepsis incidence and mortality between 2015 and 2019 in France, and to describe the characteristics of affected patients and hospital stays.DesignNationwide, population-based, retrospective observational study.SettingMetropolitan France between 2015 and 2019.ParticipantsBetween 2015 and 2019, 1 224 433 patients with sepsis of presumed bacterial aetiology were selected from the French National Hospital Discharge Database (Programme de Médicalisation des Systèmes d’Information) and were identified from corresponding ICD-10 codes for explicit sepsis or implicit sepsis.Main outcomes measuresAnnual overall and age-specific and gender-specific incidence and 95% CI, as well as trends in sepsis incidence and mortality, were estimated. Comorbidities, length of hospital stay and outcomes were described.ResultsThe sex-standardised and age-standardised incidence per 100 000 (95% CI) increased from 357 (356.0 to 359.0) in 2015 to 403 (401.9 to 405.0) in 2019 and remained higher for males compared with females. Children under 1 year and patients over 75 years consistently had the highest incidence. The most common comorbidities were cancer and chronic heart failure. The median hospital length of stay was 12 days. Most patients came from home, but only half returned home after their hospital stay and approximately 15% were discharged to long-term care. In-hospital mortality was about 25% and declined along the study period.ConclusionsMedico-administrative databases can be used to provide nationwide estimates of the in-hospital burden of bacterial sepsis. The results confirm the high burden of sepsis in France. These data should be complemented by estimating the additional burden associated with fungal and viral infections during the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 80%

Section: Discussioncontrasting

confidence: 56%

Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

et al. 2022

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“…Given that Japan has had the largest aging population worldwide since 2005, its original analysis may serve as crucial data for future clinical research and policymaking [ 12 ]. However, the nationwide epidemiology of sepsis admitted to critical care units primarily focusing on the difference between community- and hospital-onset sepsis has never been studied in Japan [ 13 – 16 ].…”

Section: Introductionmentioning

confidence: 99%

Hospital-onset sepsis and community-onset sepsis in critical care units in Japan: a retrospective cohort study based on a Japanese administrative claims database

et al. 2022

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Background Hospital- and community-onset sepsis are significant sepsis subgroups. Japanese data comparing these subgroups are limited. This study aimed to describe the epidemiology of hospital- and community-onset sepsis in critical care units in Japan. Methods We performed a retrospective cohort study using the Japanese Diagnosis and Procedure Combination database. Adult patients admitted to critical care units with sepsis from April 2010 to March 2020 were included. Sepsis cases were identified based on ICD-10 codes for infectious diseases, procedure codes for blood culture tests, and medication codes for antimicrobials. Patients’ characteristics, in-hospital mortality, and resource utilization were assessed. The in-hospital mortality between groups was compared using the Poisson regression generalized linear mixed-effect model. Results Of 516,124 patients, 52,183 (10.1%) had hospital-onset sepsis and 463,940 (89.9%) had community-onset sepsis. Hospital-onset sepsis was characterized by younger age, infrequent emergency hospitalization, frequent surgery under general anesthesia, and frequent organ support upon critical care unit admission compared to community-onset sepsis. In-hospital mortality was higher for hospital-onset than for community-onset sepsis (35.5% versus 19.2%; unadjusted mean difference, 16.3% [95% confidence interval (CI) 15.9–16.7]; adjusted mean difference, 15.6% [95% CI 14.9–16.2]). Mean hospital length of stay was longer for hospital-onset than for community-onset sepsis (47 days versus 30 days; unadjusted mean difference, 17 days [95% CI 16–17]; adjusted mean difference, 13 days [95% CI 12–14]). Conclusion Patients with hospital-onset sepsis admitted to critical care units in Japan had a poorer prognosis and more resource utilization including organ support rate, number of days with critical care unit surcharge codes, and hospital length of stay than those with community-onset sepsis.

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“…This system compiles classification files based on the diagnosis and reimbursement for medical costs during hospital stays, which has also been used in numerous epidemiological studies in other fields [ 9 – 12 ]. Using this database, we previously reported an increasing incidence of sepsis and decreased overall mortality from 2010 to 2017 [ 13 ], possibly because of the aging society and widespread use of sepsis guidelines.…”

Section: Introductionmentioning

confidence: 99%

Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database

et al. 2022

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Background Sepsis is the leading cause of death worldwide. Although the mortality of sepsis patients has been decreasing over the past decade, the trend of medical costs and cost-effectiveness for sepsis treatment remains insufficiently determined. Methods We conducted a retrospective study using the nationwide medical claims database of sepsis patients in Japan between 2010 and 2017. After selecting sepsis patients with a combined diagnosis of presumed serious infection and organ failure, patients over the age of 20 were included in this study. We investigated the annual trend of medical costs during the study period. The primary outcome was the annual trend of the effective cost per survivor, calculated from the gross medical cost and number of survivors per year. Subsequently, we performed subgroup and multiple regression analyses to evaluate the association between the annual trend and medical costs. Results Among 50,490,128 adult patients with claims, a total of 1,276,678 patients with sepsis were selected from the database. Yearly gross medical costs to treat sepsis gradually increased over the decade from $3.04 billion in 2010 to $4.38 billion in 2017, whereas the total medical cost per hospitalization declined (rate = − $1075/year, p < 0.0001). While the survival rate of sepsis patients improved during the study period, the effective cost per survivor significantly decreased (rate = − $1806/year [95% CI − $2432 to − $1179], p = 0.001). In the subgroup analysis, the trend of decreasing medical cost per hospitalization remained consistent among the subpopulation of age, sex, and site of infection. After adjusting for age, sex (male), number of chronic diseases, site of infection, intensive care unit (ICU) admission, surgery, and length of hospital stay, the admission year was significantly associated with reduced medical costs. Conclusions We demonstrated an improvement in annual cost-effectiveness in patients with sepsis between 2010 and 2017. The annual trend of reduced costs was consistent after adjustment with the confounders altering hospital expenses.

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Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database-the Japan Sepsis Alliance (JaSA) study group-

Cited by 38 publications

References 36 publications

Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

Hospital-onset sepsis and community-onset sepsis in critical care units in Japan: a retrospective cohort study based on a Japanese administrative claims database

Temporal trends of medical cost and cost-effectiveness in sepsis patients: a Japanese nationwide medical claims database

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