1201: PREVIOUSLY HEALTHY ADULTS AMONG SEPTIC PATIENTS: POPULATION-LEVEL EPIDEMIOLOGY AND OUTCOMES

Abstract

Introduction: A recent multi-center study has demonstrated that previously healthy (PH) adults are rare among patients with community-acquired sepsis, but have, unexpectedly, higher crude and adjusted short-term mortality than those with comorbidities (PC). It is unclear whether similar outcome associations are present among all septic patients in unselected, statewide populations. Methods: We used a statewide dataset to identify hospitalizations aged ≥18 years with a diagnosis of sepsis in Texas during 2018-2019. Sepsis was defined by “explicit” ICD-10 codes for severe sepsis (R65.20) and septic shock (R65.21). PH was defined as absence of the comorbidities included in the Charlson Comorbidity Index, and of obesity, malnutrition, mental disorders, and substance and alcohol use disorders. Hierarchical models were fitted to estimate the association between PH and short-term mortality (defined as in-hospital death or discharge to hospice) among all sepsis hospitalizations and for sensitivity analyses among the subsets with septic shock, ICU admission, and those undergoing invasive mechanical ventilation (IMV). Results: Among 120,371 sepsis hospitalizations, 6,611 (5.5%) were PH. Compared to those with PC, those PH were younger (aged ≥65 years 36.6% vs 56.3%), and more commonly racial/ethnic minority (51.0% vs 48.6%) and underinsured/uninsured (28.9% vs 17.5%) [p< 0.001 for all comparisons]. Short-term mortality rate was markedly lower among PH than among PC (11.7% vs 28.2%). Following adjustment for confounders, PH remained associated with lower short-term mortality (adjusted odds ratio [aOR] 0.63 [95% CI 0.57-0.69]), with consistent findings on sensitivity analyses among those with septic shock (aOR 0.75 [95% CI 0.68-0.84]) and ICU admission (aOR 0.64 [95% CI 0.57-0.71]). However, PH was no longer associated with short-term mortality among sepsis hospitalization undergoing IMV (aOR 0.99 [95% CI 0.86-1.14]). Conclusions: PH was reported in over 1 in 20 sepsis hospitalizations. The risk of short-term mortality was markedly lower among the PH group, including those with escalating illness severity, except those requiring IMV. Further studies are needed to explore the sources of the contrast with the findings of prior reports.