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Critical Care |

Trends of Clinical Features, Resource Utilization, and Outcomes in Patients With Pregnancy-Associated Severe Sepsis Requiring ICU Admission: A Population-Based Study

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


Chest. 2013;144(4_MeetingAbstracts):407A. doi:10.1378/chest.1700854
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Abstract

SESSION TITLE: Sepsis and Septic Shock

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 28, 2013 at 07:30 AM - 09:00 AM

PURPOSE: The characteristics of patients with pregnancy-associated severe sepsis (PASS) requiring ICU care were not systematically examined. We performed a trended population-based investigation of the epidemiology, clinical characteristics, resource utilization, and outcomes of ICU-treated 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. Use of ICU care, clinical characteristics (using ICD 9CM codes), resource utilization (using ICD-9CM, CPT codes, and cost center-specific charges), and outcomes were examined. Descriptive statistics, Mann Whitney U test and Chi-Square test were used.

RESULTS: There were 1007 PASS hospitalizations during study period, of whom 870 (86.4%) required ICU care. The key trends between 2001-2002 and 2009-2010 among patients admitted to the ICU were: septic shock 36% vs. 62% (p=0.0001); median (IQR) OF 1 (1-2) vs. 2 (1-3) (p<0.0001); mechanical ventilation 38% vs. 45% (p=0.06); central venous catheterization 23% vs. 49% (p<0.0001); new hemodialysis 2.3% vs. 3.7% (NS); inflation-adjusted median (IQR) ICU charges (2010 dollars) $9,785 (4,401-25,404) vs. $14,667 (7,299-42,017) [p=0.006]; hospital mortality 9.1% vs. 12.6% (NS). The genital and urinary systems were the most common sites of infection. Mean (SD) hospital LOS was 16 (19.3) days. Routine home discharge among survivors was 73% (vs. 99% among no-PASS pregnancy-associated hospitalizations; OR=0.03, p<0.0001).

CONCLUSIONS: The present cohort of PASS is the largest described to date. The severity and resource utilization among PASS patients requiring ICU admission rose markedly over the past decade, with case fatality lower and rates of ICU admission markedly higher than those reported for severely septic patients in the general population. More than 1 in 4 of hospital survivors of ICU-managed PASS did not have routine home discharge. The sources of the observed trends require further study.

CLINICAL IMPLICATIONS: Contemporary PASS patients are increasingly sicker, with near-universal ICU admission, common need for invasive interventions, often requiring increased level of care beyond hospital discharge.

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

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