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Immunosuppressed patients with sepsis have worse outcomes at less experienced hospitals
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The risk of sepsis-related death in patients who are immunosuppressed appears to be the highest in hospitals with the lowest volume of this patient population, according to a study published in the Annals of the American Thoracic Society.
“While there is a lot of focus on improving sepsis outcomes through early interventions, some patients have poor outcomes from sepsis because their chronic medical conditions may worsen after the initial infectious insult,” Jared A. Greenberg, MD, assistant professor and critical care physician at Rush University Medical Center, said in a press release. “We hypothesized that septic patients who are immunocompromised may have improved outcomes if they are managed at hospitals that have the most experience managing immunocompromising conditions.”
In the study, Greenberg and colleagues searched the Vizient Database, a consortium of 117 academic medical centers in the United States, for adult patients with sepsis who were discharged between Jan. 1, 2010, and Dec. 31, 2012.
Of these patients, the researchers identified those who were immunosuppressed based on diagnosis/discharge codes, as well as the use of specific medications. A multivariable, multilevel logistic regression model was used to evaluate the possible correlations between a patient’s immune state and their likelihood of in-hospital mortality from sepsis. Additionally, the researchers assessed whether the correlation between immune state and odds of death was impacted by the hospital’s rate of treating immunosuppressed patients with sepsis.
The researchers found that of 350,183 patients with sepsis, 20% were considered immunosuppressed. More than 15% of immunosuppressed patients with sepsis died while hospitalized vs. 12% of nonimmunosuppressed patients with sepsis.
Further analysis showed that immunosuppressed patients with sepsis had 23% greater odds of in-hospital mortality vs. nonimmunosuppressed patients with sepsis (95% CI, 20%-26%; P < .001).
In hospitals that manage fewer than 225 immunosuppressed patients with sepsis each year, patients were 38% more likely to die while hospitalized vs. a 21% greater likelihood of death at hospitals that saw 225 or more of these patients per year.
Notably, the odds of in-hospital death for immunosuppressed patients with sepsis relative to nonimmunosuppressed patients with sepsis was similar across hospitals that managed more than 225 of these patients each year.
The researchers said they were surprised to find that immunosuppressed patients were more likely than nonimmunosuppressed patients to return to their homes after discharge, perhaps because patients without immunosuppressive conditions — who tended to be older and were more likely to be admitted directly from other health care facilities — may have been more likely to experience “declining states of health prior to developing sepsis than patients with immunosuppression.”– by Jennifer Byrne
Disclosures: The authors report no relevant disclosures.
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