Risk of Cardiovascular Events in Survivors of Severe Sepsis

The risk of cardiovascular events after severe sepsis is not known, and these events may explain increased long-term mortality in survivors of severe sepsis. To determine whether survivors of severe sepsis hospitalization have high long-term risk of cardiovascular events. We examined whether higher...

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Vydáno v:American journal of respiratory and critical care medicine Ročník 189; číslo 9; s. 1065 - 1074
Hlavní autoři: Yende, Sachin, Linde-Zwirble, Walter, Mayr, Florian, Weissfeld, Lisa A., Reis, Steven, Angus, Derek C.
Médium: Journal Article
Jazyk:angličtina
Vydáno: New York, NY American Thoracic Society 01.05.2014
Témata:
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Bacterial diseases
Bacterial sepsis
Biological and medical sciences
Cardiovascular disease
Cardiovascular Diseases - diagnosis
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - etiology
Case-Control Studies
Chronic illnesses
Cohort Studies
Comorbidity
Datasets
Disease prevention
Female
Health Status
Hospitalization
Human bacterial diseases
Humans
Incidence
Infections
Infectious diseases
Intensive care
Intensive care medicine
Intensive Care Units - statistics & numerical data
Male
Medical sciences
Medicare
Medicare - statistics & numerical data
Mortality
Original
Patients
Pneumology
Propensity Score
Retrospective Studies
Risk Assessment
Sepsis
Sepsis - complications
Sepsis - epidemiology
Survivors - statistics & numerical data
United States - epidemiology
United States
Intensive care
Prognosis
Respiratory disease
Survivor
severe sepsis
Mortality
Cardiovascular disease
Risk
Epidemiology
Bacteremia
Infection
Sepsis syndrome
Risk factor
Bacteriosis
Severe
Resuscitation
sepsis
ISSN:1073-449X, 1535-4970, 1535-4970
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Shrnutí:The risk of cardiovascular events after severe sepsis is not known, and these events may explain increased long-term mortality in survivors of severe sepsis. To determine whether survivors of severe sepsis hospitalization have high long-term risk of cardiovascular events. We examined whether higher risk is due to severe sepsis hospitalization or poor prehospitalization health status, and if the higher risk is also observed in patients hospitalized for infectious and noninfectious reasons, and in other critically ill patients. Unmatched and matched-cohort analyses of Medicare beneficiaries. For unmatched analysis, we compared patients with severe sepsis admitted to the intensive care unit (ICU) and survived hospitalization (n = 4,179) to unmatched population control subjects (n = 819,283). For matched analysis, we propensity-score-matched each patient with severe sepsis to four control subjects (population, hospitalized, non-severe sepsis ICU control subjects, and infection hospitalization). Primary outcome was 1-year incidence rate of hospitalization for cardiovascular events. Cardiovascular events were common among patients discharged alive after severe sepsis hospitalization (29.5%; 498.2 events/1,000 person-years). Survivors of severe sepsis had a 13-fold higher risk of cardiovascular events compared with unmatched control subjects (498.2 vs. 36 events/1,000 person-years; P < 0.0001), and a 1.9-fold higher risk compared with matched-population control subjects (P < 0.0001). Survivors of severe sepsis had 1.1-fold higher risk compared with matched hospitalized patients and infection hospitalizations (P = 0.002 and 0.001) and similar risk compared with matched-ICU control subjects. Survivors of severe sepsis have high risk of cardiovascular events. The higher risk is mainly due to poor prehospitalization health status, and is also seen in a broader population of acutely ill patients.
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ISSN:1073-449X
1535-4970
1535-4970
DOI:10.1164/rccm.201307-1321OC