The epidemiologic characteristics, temporal trends, predictors of death, and discharge disposition in patients with a diagnosis of sepsis: A cross-sectional retrospective cohort study


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Abstract

Purpose:To assess recent epidemiologic characteristics, temporal trends, and predictors of death and discharge disposition in patients with sepsis.Material and methods:This is a cross-sectional retrospective cohort study using the US National Inpatient Sample (NIS) data from 2009 to 2012. The study population included adults (18 years and older) with sepsis-related International Classification of Diseases, Ninth Revision, Clinical Modification codes at the time of discharge. Factors associated with in-hospital mortality and patient discharge disposition were derived from multivariate analyses using multinomial logistic models by SAS PROC LOGISTIC with GLOGIT link.Results:Of 1 303 640 patients admitted, 15% died, 30% were discharged to home without home care, 34% were transferred to a skilled outpatient facility, and 4% were transferred to another short-term hospital. In-hospital mortality decreased from 16.5% to 13.8% (P < .001) across time. Length of stay also decreased from 6.7 to 5.9 days (P < .001). Reductions in mortality and length of stay were seen despite an increase in the number of comorbidities (P < .001). Multivariate analysis revealed that the strongest predictors of in-hospital mortality were respiratory, cardiovascular, and hepatic failures, and neurologic events. The predictors of transfer to an outpatient facility were a major operative procedure, neurologic event, respiratory failure, and weight loss. Weight loss was also an independent predictor of in-hospital mortality.Conclusion:Certain comorbidities and organ failures were associated with death and discharge to a skilled outpatient facility.HighlightsThe impact of sepsis-related hospitalizations on society extends well beyond lives lost. Our study adds to the body of literature describing long-term morbidity in survivors of sepsis.Given the long-term morbidity and mortality after discharge, there is a compelling need to improve postdischarge management of sepsis survivors and to further investigate the increased morbidity and mortality experienced by this population.For the developed world, enhanced patient selection for advanced medical care, especially in the intensive care unit, has great potential to alleviate suffering and reduce cost by aggressively treating infections and appropriately addressing goals of care as soon as possible.Our results indicated that weight loss was associated with in-hospital mortality and utilization of health care services upon discharge. Hence, aggressive prevention and management of nutrition during the hospital course needs to be addressed.Sex and race disparities in health care warrant further investigation. Our study indicates that more women with sepsis die in the hospital or are transferred to a skilled outpatient facility.

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