Abstract
Objective Sepsis patients are at risk of gastrointestinal bleeding (GIB) and major adverse cardiovascular events (MACEs), but few data are available on the occurrence of GIB and MACEs and their impact on sepsis outcomes. Methods The medical claims records of 220,082 patients admitted for sepsis between 1999 and 2013 were retrieved from the nationwide database. The adjusted odds ratios (aORs) of composite outcomes including the hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation (MV) in patients with a MACE or GIB were estimated by multivariate logistic regression and joint effect analyses. Results The enrollees were 70.15 ± 15.17 years of age with a hospital mortality rate of 38.91%. GIB developed in 3.80% of the patients; MACEs included ischemic stroke in 1.54%, intracranial hemorrhage (ICH) in 0.92%, and acute myocardial infarction (AMI) in 1.59%. Both ICH and AMI significantly increased the risk of (1) ICU admission (aOR = 8.02, 95% confidence interval (CI): 6.84–9.42 for ICH and aOR = 4.78, 95% CI: 4.21–5.42 for AMI, respectively), (2) receiving MV (aOR = 3.92, 95% CI: 3.52–4.40 and aOR = 1.99, 95% CI: 1.84–2.16, respectively), and (3) the hospital mortality (aOR = 1.08, 95% CI: 0.98–1.19 and aOR = 1.11, 95% CI: 1.03–1.19, respectively). However, sepsis with GIB or ischemic stroke increased only the risk of ICU admission and MV but not the hospital mortality (aOR = 0.98, 95% CI: 0.93–1.03 for GIB and aOR = 0.84, 95% CI: 0.78–0.91 for ischemic stroke, respectively). Conclusions GIB and MACEs significantly increased the risk of ICU admission and receiving MV but not the hospital mortality, which was independently associated with both AMI and ICH. Early prevention can at least reduce the complexity of clinical course and even the hospital mortality.
Highlights
Sepsis is a complex syndrome induced by severe infection and involving acute organ failure [1]
E records of 220,082 inpatients who were first admitted with a diagnosis of sepsis between 1999 and 2013 were included in the analysis. e National Health Insurance Research Database (NHIRD) is maintained by the National Health Insurance Program, which was launched by the National Health Insurance Administration (NHIA) in 1995, and currently provides coverage for more than 23.03 million residents (>99% of the entire population). e NHIRD included the data from the clinic, district hospital, regional hospital, and medical center. e confidentiality and quality of the NHIRD data have been documented in previous studies [11,12,13,14]
We systematically identified the potential confounders in the claims data. e identified confounding factors were age, sex, insurance premium, level of urbanization, baseline comorbidities, and medications. e baseline comorbidities were (1) hypertension (HTN) (ICD-9-CM: 401–405), (2) diabetes mellitus (DM) (ICD-9-CM: 250, 357.2, 362.01, 362.02, and 366.41), (3) congestive heart failure (CHF) (ICD-9-CM: 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, and 428.0), (4) chronic obstructive pulmonary disease (COPD) (ICD-9-CM: 490, 491, 492, 494, and 496), (5) chronic liver disease (CLD) (ICD-9-CM: 571), (6) chronic kidney disease (CKD) (ICD-9-CM: 581–588, 403–404, 285.21, and 250.4), and (7) cancer (ICD-9-CM: 140–208)
Summary
Sepsis is a complex syndrome induced by severe infection and involving acute organ failure [1]. Decreasing the occurrence of sepsis-associated complications would be expected to improve hospital mortality and the clinical course by reducing the need for intensive care unit (ICU). An analysis of over 119,000 patients hospitalized with sepsis between 2003 and 2012 and included in a nationwide database in the USA estimated that the incidence of GIB was Emergency Medicine International. Concurrent GIB was found to increase sepsis mortality by 9% [5]. Sepsis-associated atrial fibrillation, coagulopathy, hemodynamic instability, and prolonged systemic inflammation act to trigger acute ischemic stroke. Ischemic stroke events are not unusual in patients with sepsis and thrombocytopenia, but the cause appears to be complex [6,7,8,9]
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