Abstract
BackgroundIt remains unclear whether sepsis-related cardiovascular complications have an adverse impact on survival independent of pre-existing comorbidities. To investigate the survival impact of post-sepsis cardiovascular complications among sepsis survivors, we conducted a population-based study using the National Health Insurance Database of Taiwan.MethodsWe identified sepsis patients from the National Health Insurance Research Database of Taiwan using ICD-9-CM codes involving infection and organ dysfunction between 2000 and 2011. Post-sepsis incident myocardial infarction (MI) and stroke were ascertained by ICD-9-CM codes and antiplatelet treatment. We constructed a non-sepsis comparison cohort using propensity score matching to ascertain the association between sepsis and cardiovascular complications. Furthermore, we compared the 180-day mortality and 365-day mortality between patients surviving sepsis with or without post-sepsis MI or stroke within 70 days of hospital discharge. We constructed Cox regression models adjusting for pre-existing comorbidities to evaluate the independent survival impact of post-sepsis MI or stroke among sepsis survivors.ResultsWe identified 42,316 patients hospitalized for sepsis, from which we matched 42,151 patients 1:1 with 42,151 patients hospitalized without sepsis. Compared to patients hospitalized without sepsis, patients hospitalized with sepsis had an increased risk of MI or stroke (adjusted odds ratio 1.72, 95% CI 1.60–1.85). Among 42,316 patients hospitalized for sepsis, 486 (1.15%) patients developed incident stroke and 108 (0.26%) developed incident MI within 70 days of hospital discharge. Compared to sepsis survivors without cardiovascular complications, sepsis survivors with incident MI or stroke had a higher mortality rate at 180 days (11.68% vs. 4.44%, P = 0.003) and at 365 days (16.75% vs. 7.11%, P = 0.005). Adjusting for age, sex, and comorbidities, post-sepsis MI or stroke was independently associated with increased 180-day (adjusted hazard ratio [HR] 2.16, 95% CI 1.69–2.76) and 365-day (adjusted HR 1.90, 95% CI 1.54–2.32) mortality.ConclusionsCompared to sepsis patients without incident MI or stroke, sepsis patients with incident MI or stroke following hospital discharge had an increased risk of mortality for up to 365 days of follow-up. This increased risk cannot be explained by pre-sepsis comorbidities.
Highlights
It remains unclear whether sepsis-related cardiovascular complications have an adverse impact on survival independent of pre-existing comorbidities
Baseline characteristics of study patients From one million National Health Insurance Research Database (NHIRD) participants, we identified 42, 316 patients who were hospitalized with sepsis (Fig. 1)
Adjusting for demographic variables and potential confounders in the Cox proportional hazard model, we found a significant increase in 180-day mortality for patients with post-sepsis myocardial infarction (MI), postsepsis stroke (HR 2.19, 95% CI 1.67, 2.87), and composite post-sepsis MI/stroke (HR 2.02, 95% CI 1.65, 2.47) as compared with patients without post-sepsis MI/stroke (Table 2)
Summary
It remains unclear whether sepsis-related cardiovascular complications have an adverse impact on survival independent of pre-existing comorbidities. To investigate the survival impact of post-sepsis cardiovascular complications among sepsis survivors, we conducted a population-based study using the National Health Insurance Database of Taiwan. Recent studies have suggested that the increased risk of mid- to long-term mortality after sepsis cannot be explained by the preexisting comorbid conditions before sepsis and might be attributed to increased post-sepsis cardiovascular complications instead [3]. Consistent with prior literature, our previous work using the National Health Insurance Research Database of Taiwan demonstrated that patients with sepsis are at markedly elevated risk of incident MI/stroke during the first 70 days after hospital discharge [11]. We found that after this critical 70-day period, sepsis survivors have a comparable risk of post-sepsis MI/stroke with non-sepsis control patients
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