Trends and outcomes of severe sepsis in hematopoietic stem cell transplant recipients.

Abstract

7127 Background: Sepsis is common in hematopoietic stem cell transplant (HSCT) patients due to deficient immune system in the early part of the transplant and in patients with graft versus host disease (GVHD). There is very limited data on outcomes and trends of severe sepsis (SS) in these groups of patients. Methods: Using the Nationwide Inpatient Sample 2000-2008, patients older than 18 years, discharged with SS were identified using ICD-9-CM codes. Status of HSCT was identified using ICD-9-CM codes 41.0x. We also identified subsequent hospital admissions using ICD-9-CM codes V42.81-82 and 996.85 and GVHD using 279.5x. Hospital mortality was the primary outcome studied. Chi square test was used for comparison. Logistic regression model was constructed to examine the independent effect of HSCT on mortality in patients with SS. We adjusted for age, gender, race, insurance, hospital characteristics, Charlson's co-morbidity index and severity of sepsis using number of organ failures. Results: Of the 291,182 admissions with HSCT from 2000 to 2008, 7.5% had SS. The rate of SS was 5 times higher in HSCT when compared to non transplant group. In engraftment period, allogenic transplant had higher rates of SS when compared to autologous (13.2% vs. 5.2%, p<0.001). During engraftment, in-hospital mortality with SS was higher in allogenic transplant (55.1%) compared to autologous group (30.1%) (mortality in non-transplant was 32.9%). On adjusted analysis, compared to non transplant group, the odds of mortality was 4.69 times (95%CI 2.85-7.69) higher in allogenic transplants while it was similar in autologous group. In subsequent admissions, the odds of mortality were 2.38 times (95%CI 2.10-2.69) higher in GVHD and 1.45 times higher (95%CI 1.28-1.65) in non-GVHD patients when compared to the non-transplant group. The in-hospital mortality in HSCT decreased from the year 2000 to 2004 but has not changed ever since, while in the non-transplant group the mortality has continued to decrease. Conclusions: Higher mortality is observed in allogenic transplant patients and in those developing GVHD when compared to non-transplant patients. The mortality due to SS in HSCT patients has not changed since 2004 and may warrant more aggressive interventions.