Individuals discharged after hospitalization with sepsis have a higher risk of cardiovascular events, rehospitalization for any cause, or death than those hospitalized and without sepsis. Journal of the American Heart AssociationOpen access, peer-reviewed Journal of the American Heart Association.
Sepsis is a leading cause of hospitalization and death worldwide. Each year in the U.S., about 1.7 million people develop sepsis, an extreme immune response to an infection in the bloodstream that can spread throughout the body and lead to organ failure and possibly death.
“We know that infection can be a potential trigger for myocardial infarction or heart attack, and that infection can predispose the patient to other cardiac events, either directly during the infection or later when the infection and related effects on the body promote progressive heart disease.” The study’s lead author, Jacob C. Genger, MD, FAHA, assistant professor of medicine in the Department of Cardiovascular Medicine at the Mayo Clinic in Rochester, Minnesota. “We sought to describe the association between hospitalization and subsequent death and sepsis during rehospitalization in a large cohort of adults.”
In this study, researchers examined whether adults with sepsis may have a higher risk of death and a higher risk of rehospitalization for cardiovascular events after hospital discharge. They queried a database containing administrative claims data and identified more than 2 million enrollees of occupational and Medicare Advantage insurance across the United States who had two or more nights of nonsurgical hospitalization between 2009 and 2019. Among these patients, who were 19-years-old. 87 years, medical claims indicate that more than 800,000 had sepsis during their hospital stay. The researchers analyzed the association of hospitalization with sepsis, rehospitalization and death during the follow-up period from 2009 to 2021.
Because differences in sepsis diagnosis and documentation can affect outcomes in research and clinical treatment, the researchers included two standard diagnostic codes used for sepsis: overt and implicit. Apparent sepsis is when a doctor formally diagnoses a patient. Implicit sepsis is an administrative code in the electronic health record when a patient has both infection and organ failure, which is the currently accepted definition of sepsis. The presence of any definition of sepsis was used to classify patients as having sepsis versus no sepsis.
To focus on the potential cardiovascular impact of sepsis, researchers compared 808,673 hospitalized patients with sepsis to 1,449,821 hospitalized patients who did not develop sepsis but still had cardiovascular disease or one or more cardiovascular risk factors (older age, hypertension, hyperlipidemia, type 2). were diabetes, chronic kidney disease, obesity or smoking).
The analysis found:
- Compared to patients without sepsis during their hospital stay, patients with sepsis were 27% more likely to die, 38% more likely to be hospitalized for any reason, and 43% more likely to be readmitted to the hospital specifically for cardiovascular reasons. 12 years after sepsis.
- Heart failure was the most common major cardiovascular event (including stroke, heart attack, arrhythmia, and heart failure) in people with sepsis. Individuals with sepsis during hospitalization had a 51% higher risk of heart attack during the follow-up period.
- Patients with implicit sepsis (infection with organ failure) had a two-fold increased risk of rehospitalization for cardiovascular events compared with overt sepsis (a formal diagnosis by a physician).
“Our findings indicate that after hospitalization with sepsis, close follow-up care is important, and it may be valuable to implement cardiovascular prevention therapies under close supervision,” Gentzer said. “Professionals need to be aware that people with prior sepsis are at very high risk for cardiovascular events, and may need to counsel them to increase the intensity of their cardiovascular prevention.”
The study authors will continue to evaluate new data on people with prior sepsis during hospitalization to map their needs for cardiovascular preventive therapies. “This is an important opportunity to establish what may and may not work in the future for people with sepsis,” Gentzer said.
The main limitation of the study is that it is a retrospective cohort study that uses data collected through hospital administration. This means the researchers were evaluating past records and did not have information on the severity of sepsis.
Co-authors Patrick R. Lawler, MD, MPH; Holly K. Van Houten, BA; Xiaoxi Yao, Ph.D., MPH; Kianoush B. Kashani, MD, MS; and Shannon M. Donley, MD, MS Author disclosures are listed in the manuscript.
This study was conducted by Mayo Clinic Robert D. and was supported by the Patricia E. Kern Center for the Science of Health Care Delivery and the Mayo Clinic Department of Cardiovascular Medicine.