N2. HAI Surveillance and public reporting
Oral Abstract Submission
Background : Devastating cases of sepsis in previously healthy patients have received widespread attention and helped catalyze state and national mandates to improve sepsis detection and care. It is unclear, however, what proportion of sepsis cases occur in previously healthy people and how their outcomes compare to patients with comorbidities.
We conducted a retrospective study of adults admitted from 2009-2015 to 373 US hospitals from 3 cohorts using detailed electronic health record data. We identified patients with community-onset sepsis using CDC Adult Sepsis Event criteria and reviewed patients’ ICD-9-CM codes to identify major and minor comorbidities. Generalized linear mixed models were used to identify the association between healthy vs comorbid status and short-term mortality (in-hospital death or discharge to hospice) among sepsis patients, controlling for demographics and clinical characteristics.
The cohort included 6,715,286 adult hospitalizations, of which 337,983 (5%) met community-onset sepsis criteria. Most (329,052; 97.4%) sepsis patients had at least one comorbidity (96.1% major, 1.2% minor, 0.1% pregnant) whereas the minority (8,931; 2.6%) were previously healthy. Hospitalized patients without sepsis, by contrast, tended to be healthier (6.2%, Figure 1). Compared with sepsis patients with comorbidities, previously healthy sepsis patients were younger (mean 48.3 + 20 vs 66.9 + 16.5 years, p< 0.001) and less likely to require ICU care on admission (30.9% vs 50.5%, p< .001). Previously healthy patients were more likely to be discharged home vs subacute facilities compared to sepsis patients with comorbidities but had higher short-term mortality rates (22.7% vs 20.8%, p< .001) (Figure 2). The increased risk of short-term death in healthy patients persisted on multivariate analysis (adjusted odds ratios 1.36-1.79, p< .001).
The vast majority of patients who develop community-onset sepsis have pre-existing conditions. However, previously healthy patients may be at higher risk for death due to sepsis compared to patients with comorbidities. These findings provide context for high-profile reports about sepsis deaths in previously healthy people and underscore the importance of early sepsis recognition and treatment for all patients.