PURPOSE:CS use is associated with higher risk of infection. However, there is limited data available regarding the impact of outpatient CS on sepsis-related mortality. Therefore, our aim was to examine the effect of prior outpatient CS use on 30-day mortality for patients hospitalized with sepsis.
METHODS:A retrospective national cohort study conducted using Department of Veterans Affairs (VA) administrative data of patients >64 years of age hospitalized with sepsis in fiscal year 2000 and having at least one year of prior VA outpatient care. We excluded patients with a history of human immunodeficiency virus infection. Patients were defined as using CS if they had filled at least a 30-day prescription within 90-days prior to admission. Our primary analysis was a multilevel regression model with the dependent variable of 30-day mortality and independent variables including demographics, Charlson score, and CS use.
RESULTS:We identified 3018 patients hospitalized with sepsis that met our inclusion/exclusion criteria. The mean age was 74 years, 98.5% were male, and 26.9% of subjects died within 30-days of presentation. Regarding medication use, 15.7% of subjects received prior outpatient CS. After adjusting for potential confounders, prior CS use (odds ratio 1.21, 95% confidence interval 0.95–1.55) was not significantly associated with increased 30-day mortality.
CONCLUSION:Use of outpatient CS prior to admission was not associated with increased mortality in patients hospitalized with sepsis. In contrast to our a priori hypothesis, prior outpatient CS use was not associated with 30-day mortality, but it may affect other outcomes including acquisition of highly resistant pathogens, unusual pathogens, and contribute to higher morbidity and cost.
CLINICAL IMPLICATIONS:Further research is needed to examine the impact of CS on outcomes for patients with sepsis.
DISCLOSURE:Rosa Malo De Molina Ruiz, No Financial Disclosure Information; No Product/Research Disclosure Information