94: Delivery-associated sepsis: trends in morbidity and mortality

Abstract

Sepsis is a leading cause of pregnancy-related mortality. We aimed to provide updated national estimates of the prevalence and trends of sepsis, sepsis-related in-hospital mortality, and patient characteristics and comorbid conditions associated with sepsis and mortality at delivery. We conducted a serial, cross-sectional analysis using data from the 2002-15 National Inpatient Sample, the largest all-payer inpatient database in the United States. We used ICD-9-CM diagnosis and procedure codes to identify the study sample of delivery-related hospitalizations, and to capture diagnoses of sepsis (defined as infection with associated end-organ dysfunction), chronic comorbidities, and pregnancy-related outcomes. Logistic regression was used to explore factors associated with sepsis during pregnancy, and among those with sepsis, to identify predictors of in-hospital mortality. Joinpoint regression was used to estimate the temporal trends in both sepsis and in-hospital mortality. Of the more than 55 million delivery-associated hospitalizations, 13,129 women met criteria for sepsis, corresponding to a rate 2.4 per 10,000. This rate increased from 1.2 to 3.7 per 10,000 over the 14-year study period, representing an annual percentage increase of 6.7% (95% CI: 4.2, 9.1). Non-Hispanic black women had higher rates of sepsis than non-Hispanic white women (4.6 vs. 1.9 per 10,000). Women 40 years or older were more likely to have sepsis compared to teenage women (8.0 vs. 2.3 per 10,000). Compared to women without sepsis, women with sepsis had higher rates of preterm delivery (17.7% vs. 7.0%) and cesarean delivery (45.0% vs 31.2%). One in 11 women with sepsis died prior to discharge, compare to 1 death in every 15,390 deliveries without sepsis. The sepsis-related mortality rate remained stable during 2002-2010 but decreased 21.8% each year from 2010-2015. Among women with sepsis, after controlling for socio-demographic, clinical, and hospital-level confounders, age 40 years or older [aOR 2.10 (95%CI 1.30, 3.39)], Medicaid insurance [aOR 1.62 (95%CI 1.16, 2.25)], HIV [aOR 3.96 (1.82, 8.62), and chronic liver disease [aOR 3.27 (1.79, 5.97)] were associated with increased odds of in-hospital death. While rates of delivery-related sepsis have increased, case fatality has decreased.