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The Epidemiology, Clinical Features, and Resource Utilization Trends in Pregnancy-Associated Severe Sepsis: A Population-Based Cohort Study FREE TO VIEW

Lavi Oud, MD; Phillip Watkins, MS; Moss Hampton, MD
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Texas Tech University HSC, Odessa, TX

Chest. 2013;144(4_MeetingAbstracts):416A. doi:10.1378/chest.1700822
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Only limited data were reported to date on the contemporary features of pregnancy-associated severe sepsis (PASS), focusing mostly on delivery hospitalizations. We performed a trended population-based investigation of the epidemiology, clinical characteristics, and resource utilization of PASS in Texas over the past decade.

METHODS: We used the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations for the years 2001-2010. ICD-9CM codes for infection plus organ failure (OF) were then used to identify PASS hospitalizations. The Texas Center for Health Statistics reports of live births, abortions and fetal deaths, and previously reported population-based, age-specific linkage data on miscarriage were used to estimate the annual total number of pregnancies (TEP). Incidence of PASS, clinical characteristics, resource utilization and outcomes were examined. Descriptive statistics, Mann Whitney and Chi-Square tests were used.

RESULTS: There were 5,347,084 TEP and 1007 PASS hospitalizations during study period. Delivery hospitalizations accounted for 38% of all PASS hospitalizations. The key trends between 2001-2002 and 2009-2010 within PASS hospitalizations were: age-adjusted incidence per 100,000 TEP 11 vs. 27 (p=0.009); chronic comorbidities 28% vs. 33% (NS); development of ≥3 OF 9% vs. 35% (p<0.0001); admission to ICU 78% vs. 90% (p=0.002), inflation-adjusted median hospital charges (2010 dollars) $52,830 vs. $88,659 (p=0.0001), hospital mortality 9.7% vs. 12% (NS), PASS contribution to all pregnancy-associated inpatient deaths 11.5% vs. 28.1% (p=0.004). The genital and urinary systems were the most common sites of infection. Mean (SD) hospital LOS was 12.4 (14.6) days.

CONCLUSIONS: The present cohort of PASS is the largest described to date. The incidence, severity, and costs of PASS rose significantly over the past decade. While case fatality is lower than that for severe sepsis in the general population, PASS contributes increasingly to maternal hospital death. Focus on delivery hospitalizations underestimates the full burden of PASS. The sources of the observed trends require further study.

CLINICAL IMPLICATIONS: The relative infrequency of PASS, coupled with its high severity and resource-intense needs remain a clinical challenge for timely diagnosis and effective intervention.

DISCLOSURE: The following authors have nothing to disclose: Lavi Oud, Phillip Watkins, Moss Hampton

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