Sepsis may be nontraditional risk factor for HF, rehospitalization
Adults who survive a hospitalization with sepsis are at substantially increased risk for post-discharge death and CV events resulting in hospitalization, researchers reported.
In a database analysis of more than 2.2 million patients, researchers also found that the excess risk among patients with sepsis was particularly high for HF hospitalization, showing a more than 50% increased risk during follow-up, according to Jacob C. Jentzer, MD, director of research for the cardiac intensive care unit and assistant professor of medicine in the department of cardiovascular medicine at Mayo Clinic.
“Providers care for sepsis survivors during and after hospitalization should ensure that these patients receive appropriate medications for prevention of CV events based on their known diseases and risk factors, avoid unnecessary or inadvertent discontinuation of CV prevention medications, and provide close follow-up to monitor for development of new CV events,” Jentzer told Healio.
Link between sepsis and CV events
Jentzer and colleagues analyzed data from 2,258,464 adults who survived any nonsurgical hospitalization that required a stay of at least 2 nights from 2009 to 2019, using data from OptumLabs Data Warehouse. Researchers assessed the association between sepsis during the hospitalization with subsequent death and rehospitalization using Kaplan-Meier survival analysis and multivariable Cox proportional-hazards models.
The findings were published in the Journal of the American Heart Association.
Researchers found that during the study period consisting of 5,396,051 patient-years of post-discharge follow-up, 35.8% of patients had a sepsis hospitalization, including implicit sepsis only in 448,644, explicit sepsis only in 124,841 and both in 235,188.
Patients with sepsis during hospitalization had a 27% elevated risk for all-cause mortality (adjusted HR = 1.27; 95% CI, 1.25-1.28; P < .001), as well as 38% increased risk for all-cause rehospitalization (aHR = 1.38; 95% CI, 1.37-1.39; P < .001) and a 43% increased risk for any CV hospitalization (aHR = 1.43; 95% CI, 1.41-1.44; P < .001).
Risk was particularly high for HF hospitalization among patients with sepsis (aHR = 1.51; 95% CI, 1.49-1.53). Those with implicit sepsis had higher risk than those with explicit sepsis, according to researchers.
The researchers noted that the excess risk for CV events among sepsis survivors is substantial enough that sepsis should be considered a nontraditional risk factor for CV events.
“It is essential to determine what, if any, preventive medications can reduce the risk for future CV events in sepsis survivors, whether this might be escalation or adjustment of preexisting CV preventive therapies or addition of established or novel preventive therapies,” Jentzer told Healio.
Recognize post-discharge burden of sepsis
In a related editorial, Gabriel Wardi, MD, MPH, associate professor of clinical emergency medical services at UC San Diego Health, and colleagues wrote that questions remain about the findings; however, the data should alert providers to the importance of an episode of sepsis as a major event in their patient’s medical history.
“Prompt attention and recognition of the post-discharge burden of sepsis coupled with meticulous post-discharge care and cardiovascular risk stratification may potentially improve patient-centered outcomes,” Wardi and colleagues wrote. “Future clinical investigations should include diverse groups of individuals and assess whether sepsis is truly an independent cardiovascular risk factor and how interventions impact these outcomes.”
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For more information:
Jacob C. Jentzer, MD, can be reached at jentzer.jacob@mayo.edu.
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