Team unearths surprising sepsis finding

Red blood cells

Credit: NHLBI

SAN DIEGO—Results of a retrospective study suggest sepsis may contribute to as many as half of all hospital deaths in the US.

Researchers analyzed information from 6.5 million hospital discharge records and found that, of all hospital deaths, as many as 52% occurred in patients with sepsis.

“We were surprised to find that as many as 1 in 2 patients dying in US hospitals had sepsis,” said Vincent Liu, MD, of the Kaiser Permanente Northern California Division of Research.

He and his colleagues presented this finding at the American Thoracic Society’s 2014 International Conference (abstract 50626). The results have also been published in JAMA.

The researchers analyzed data from 6.5 million hospital discharge records derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) in 2010. The NIS is the largest publicly available, all-payer inpatient database in the US, containing data from 100% of hospital discharges from a stratified sample of 1051 community hospitals.

The team also evaluated records for 482,828 adult patients admitted to 21 Kaiser Permanente Northern California (KPNC) hospitals.

Using diagnosis and procedure codes, the researchers identified hospital admissions and deaths of patients with sepsis and estimated the percentage of total hospital charges associated with sepsis hospitalizations.

They used 2 approaches to identify patients with sepsis from International Statistical Classification of Diseases, Ninth Revision, Clinical Modification codes. The explicit approach identified patients with codes 038 (septicemia), 995.91 (sepsis), 995.92 (severe sepsis), or 785.52 (septic shock). The team also used an implicit approach, which included patients with evidence of both infection and acute organ failure.

In the NIS cohort, there were 280,663 explicit and 717,718 implicit sepsis hospitalizations. Sepsis hospitalizations accounted for 4.3% (explicit) to 10.9% (implicit) of all hospitalizations.

There were 143,312 deaths in the NIS cohort, and 34.7% (explicit) to 52.0% (implicit) occurred among patients with sepsis.

In the KPNC cohort, there were 55,008 explicit and 80,678 implicit sepsis hospitalizations. Sepsis hospitalizations accounted for 11.4% (explicit) to 16.7% (implicit) of all hospitalizations.

There were 14,206 inpatient deaths in this cohort, and 36.9% (explicit) to 55.9% (implicit) occurred among patients with sepsis.

“[W]e found that most patients already had sepsis at the time of hospital admission,” Dr Liu said. “There was also a large number of patients with less severe sepsis, a group for whom treatment guidelines are less well-defined. The results of our study suggest that improved care for sepsis patients of all severity levels and in all hospital settings could result in many future lives saved.”

Red blood cells

Credit: NHLBI

SAN DIEGO—Results of a retrospective study suggest sepsis may contribute to as many as half of all hospital deaths in the US.

Researchers analyzed information from 6.5 million hospital discharge records and found that, of all hospital deaths, as many as 52% occurred in patients with sepsis.

“We were surprised to find that as many as 1 in 2 patients dying in US hospitals had sepsis,” said Vincent Liu, MD, of the Kaiser Permanente Northern California Division of Research.

He and his colleagues presented this finding at the American Thoracic Society’s 2014 International Conference (abstract 50626). The results have also been published in JAMA.

The researchers analyzed data from 6.5 million hospital discharge records derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) in 2010. The NIS is the largest publicly available, all-payer inpatient database in the US, containing data from 100% of hospital discharges from a stratified sample of 1051 community hospitals.

The team also evaluated records for 482,828 adult patients admitted to 21 Kaiser Permanente Northern California (KPNC) hospitals.

Using diagnosis and procedure codes, the researchers identified hospital admissions and deaths of patients with sepsis and estimated the percentage of total hospital charges associated with sepsis hospitalizations.

They used 2 approaches to identify patients with sepsis from International Statistical Classification of Diseases, Ninth Revision, Clinical Modification codes. The explicit approach identified patients with codes 038 (septicemia), 995.91 (sepsis), 995.92 (severe sepsis), or 785.52 (septic shock). The team also used an implicit approach, which included patients with evidence of both infection and acute organ failure.

In the NIS cohort, there were 280,663 explicit and 717,718 implicit sepsis hospitalizations. Sepsis hospitalizations accounted for 4.3% (explicit) to 10.9% (implicit) of all hospitalizations.

There were 143,312 deaths in the NIS cohort, and 34.7% (explicit) to 52.0% (implicit) occurred among patients with sepsis.

In the KPNC cohort, there were 55,008 explicit and 80,678 implicit sepsis hospitalizations. Sepsis hospitalizations accounted for 11.4% (explicit) to 16.7% (implicit) of all hospitalizations.

There were 14,206 inpatient deaths in this cohort, and 36.9% (explicit) to 55.9% (implicit) occurred among patients with sepsis.

“[W]e found that most patients already had sepsis at the time of hospital admission,” Dr Liu said. “There was also a large number of patients with less severe sepsis, a group for whom treatment guidelines are less well-defined. The results of our study suggest that improved care for sepsis patients of all severity levels and in all hospital settings could result in many future lives saved.”

Red blood cells

Credit: NHLBI

SAN DIEGO—Results of a retrospective study suggest sepsis may contribute to as many as half of all hospital deaths in the US.

Researchers analyzed information from 6.5 million hospital discharge records and found that, of all hospital deaths, as many as 52% occurred in patients with sepsis.

“We were surprised to find that as many as 1 in 2 patients dying in US hospitals had sepsis,” said Vincent Liu, MD, of the Kaiser Permanente Northern California Division of Research.

He and his colleagues presented this finding at the American Thoracic Society’s 2014 International Conference (abstract 50626). The results have also been published in JAMA.

The researchers analyzed data from 6.5 million hospital discharge records derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) in 2010. The NIS is the largest publicly available, all-payer inpatient database in the US, containing data from 100% of hospital discharges from a stratified sample of 1051 community hospitals.

The team also evaluated records for 482,828 adult patients admitted to 21 Kaiser Permanente Northern California (KPNC) hospitals.

Using diagnosis and procedure codes, the researchers identified hospital admissions and deaths of patients with sepsis and estimated the percentage of total hospital charges associated with sepsis hospitalizations.

They used 2 approaches to identify patients with sepsis from International Statistical Classification of Diseases, Ninth Revision, Clinical Modification codes. The explicit approach identified patients with codes 038 (septicemia), 995.91 (sepsis), 995.92 (severe sepsis), or 785.52 (septic shock). The team also used an implicit approach, which included patients with evidence of both infection and acute organ failure.

In the NIS cohort, there were 280,663 explicit and 717,718 implicit sepsis hospitalizations. Sepsis hospitalizations accounted for 4.3% (explicit) to 10.9% (implicit) of all hospitalizations.

There were 143,312 deaths in the NIS cohort, and 34.7% (explicit) to 52.0% (implicit) occurred among patients with sepsis.

In the KPNC cohort, there were 55,008 explicit and 80,678 implicit sepsis hospitalizations. Sepsis hospitalizations accounted for 11.4% (explicit) to 16.7% (implicit) of all hospitalizations.

There were 14,206 inpatient deaths in this cohort, and 36.9% (explicit) to 55.9% (implicit) occurred among patients with sepsis.

“[W]e found that most patients already had sepsis at the time of hospital admission,” Dr Liu said. “There was also a large number of patients with less severe sepsis, a group for whom treatment guidelines are less well-defined. The results of our study suggest that improved care for sepsis patients of all severity levels and in all hospital settings could result in many future lives saved.”