TRENDS, PREDICTORS AND OUTCOMES OF INVASIVE VENTILATION UTILIZATION DURING HOSPITALIZATIONS DUE TO SEPSIS

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Sepsis is a life-threatening multi-organ dysfunction caused by a dysregulated host response to infection. Respiratory distress during the sepsis which may require ventilation support contribute to higher morbidity and mortality among hospitalized patients with sepsis. Population based studies are lacking in estimating the burden of respiratory distress among sepsis patients. In this study we aim to outline temporal trends, factors associated and outcomes of Invasive Mechanical Ventilation (IMV) during hospitalizations due to sepsis. METHODS: Study cohort is derived from the Nationwide Inpatient Sample (NIS) for the years 2008-2017. Adult Hospitalizations due to septicemia were identified using International Classification of Diseases (9th/10th Editions) Clinical Modification (ICD-9-CM/ICD-10-CM). We excluded patients with pregnancy from the final cohort. IMV and other diagnosis of interests were identified by ICD-9/10-CM procedural codes and comorbidities by Elixhauser comorbidity software. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression models to analyze temporal trends, predictors and outcomes. RESULTS: Out of total 12,980,000 hospitalizations due to sepsis from 2007-2017, IMV was utilized among 1,973,261 (15.2%). Proportion of IMV utilization has decreased from 17.6% in 2008 to 12.9% in 2017 with a 6% yearly decrease (OR 0.94; 95%CI,0.93-0.95; p<0.01). In multivariable regression analysis, female (OR 1.2; 95%CI 1.1-1.2; p<0.01), African-Americans (OR 1.1; 95% CI 1.1-1.2; p<0.01), lower household income (OR 1.2; 95% CI 1.1-1.2; p<0.01), west hospital region (OR 1.2; 95%CI 1.2-1.3; p<0.01), weekend admission (OR 1.1; 95%CI 1.1-1.1; p<0.01) as well as concurrent conditions like Obesity (OR 1.1; 95%CI 1.1-1.2; P<0.01), DIC, pneumonia, chronic lung disease, weight loss, and alcohol were associated with higher odds of IMV requirement. After adjusting the confounding factors IMV was a major contributing factor to increase in-hospital mortality (OR 11.4; 95%CI 11.2-11.5; p<0.01) and discharge to facilities (OR 2.7; 95%CI 2.6-2.8; p<0.01). In trend analysis in-hospital mortality has been decreased (45% in 2007 to 35% in 2017; p:<0.01) however discharge to facilities has been increased. CONCLUSIONS: We observed a decreasing trend of IMV among hospitalized sepsis patients with overall improvement over the years. However, IMV utilization is attributing to significantly high in-hospital mortality and morbidity. Furthermore, we also identified risk factors associated with increased IMV use. CLINICAL IMPLICATIONS: Our study advocates the need for a better risk stratification among patients with sepsis and comorbidities. Further in-depth studies are warranted to understand the causality of some of the potentially modifiable risk factors associated with ventilation requirement. Over the long term, this may help improve the outcomes further. DISCLOSURES: No relevant relationships by Mageda Al areqi, source=Web Response No relevant relationships by Suryadev Allam, source=Web Response No relevant relationships by Srilatha Eapi, source=Web Response No relevant relationships by apurwa karki, source=Web Response No relevant relationships by Phuoc Nguyen, source=Web Response No relevant relationships by Achint Patel, source=Web Response No relevant relationships by Harshil Shah, source=Web Response No relevant relationships by Karine Vartanian, source=Web Response