Background

Devastating cases of sepsis in previously healthy patients have received widespread attention and have helped to catalyze state and national mandates to improve sepsis detection and care. However, it is unclear what proportion of patients hospitalized with sepsis previously were healthy and how their outcomes compare with those of patients with comorbidities.

Research Question

Among adults hospitalized with community-onset sepsis, how many previously were healthy and how do their outcomes compare with those of patients with comorbidities?

Study Design and Methods

We retrospectively identified all adults with community-onset sepsis hospitalized in 373 US hospitals from 2009 through 2015 using clinical indicators of presumed infection and organ dysfunction (Centers for Disease Control and Prevention’s Adult Sepsis Event criteria). Comorbidities were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We applied generalized linear mixed models to measure the associations between the presence or absence of comorbidities and short-term mortality (in-hospital death or discharge to hospice), adjusting for severity of illness on admission.

Results

Of 6,715,286 hospitalized patients, 337,983 (5.0%) were hospitalized with community-onset sepsis. Most patients with sepsis (329,052 [97.4%]) had received a diagnosis of at least one comorbidity; only 2.6% previously were healthy. Patients with sepsis who previously were healthy were younger than those with comorbidities (mean age, 58.0 ± 19.8 years vs 67.0 ± 16.5 years), were less likely to require ICU care on admission (37.9% vs 50.5%), and were more likely to be discharged home (57.9% vs 45.6%), rather than to subacute facilities (16.3% vs 30.8%), but showed higher short-term mortality rates (22.8% vs 20.8%; P < .001 for all). The association between previously healthy status and higher short-term mortality persisted after risk adjustment (adjusted OR, 1.99; 95% CI, 1.87-2.13).

Interpretation

The vast majority of patients hospitalized with community-onset sepsis harbor pre-existing comorbidities. However, previously healthy patients may be more likely to die when they seek treatment at the hospital with sepsis compared with patients with comorbidities. These findings underscore the importance of early sepsis recognition and treatment for all patients.

中文翻译：

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社区发病脓毒症住院患者中先前健康成年人的患病率和结果

背景

以前健康的患者发生的毁灭性脓毒症病例受到了广泛关注，并有助于促进州和国家改善脓毒症检测和护理的要求。然而，目前尚不清楚之前因脓毒症住院的患者中有多少比例是健康的，以及他们的结果与患有合并症的患者相比如何。

研究问题

在因社区发病脓毒症住院的成年人中，有多少人以前是健康的？他们的结果与患有合并症的患者相比如何？

研究设计和方法

我们使用推定感染和器官功能障碍的临床指标（美国疾病控制与预防中心的成人脓毒症事件标准）回顾性识别了 2009 年至 2015 年在美国 373 家医院住院的所有社区发病脓毒症成人。使用国际疾病分类第九版临床修改代码来识别合并症。我们应用广义线性混合模型来衡量是否存在合并症与短期死亡率（院内死亡或出院到临终关怀中心）之间的关联，并根据入院时疾病的严重程度进行调整。

结果

在 6,715,286 名住院患者中，337,983 名 (5.0%) 因社区发病的脓毒症住院。大多数脓毒症患者 (329,052 [97.4%]) 被诊断出至少患有一种合并症；之前只有 2.6% 是健康的。既往健康的脓毒症患者比患有合并症的患者更年轻（平均年龄，58.0 ± 19.8 岁 vs 67.0 ± 16.5 岁），入院时需要 ICU 护理的可能性较小（37.9% vs 50.5%），并且更有可能出院回家（57.9% vs 45.6%），而不是去亚急性机构（16.3% vs 30.8%），但短期死亡率更高（22.8% vs 20.8%；所有 P < .001  ）。风险调整后，先前的健康状况与较高的短期死亡率之间的关联仍然存在（调整后的 OR，1.99；95% CI，1.87-2.13）。

解释

绝大多数因社区发病败血症而住院的患者都患有既存的合并症。然而，与患有合并症的患者相比，以前健康的患者在因脓毒症到医院寻求治疗时可能更有可能死亡。这些发现强调了早期脓毒症识别和治疗对所有患者的重要性。