Critical Care: Critical Care: Sepsis |

Comorbid Conditions Predict Outcomes in Patients With Severe Sepsis FREE TO VIEW

Bristol Whiles; Amanda Deis; Patrick Miller; Steven Simpson
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University of Kansas School of Medicine, Kansas City, KS

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A170. doi:10.1016/j.chest.2016.02.176
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SESSION TITLE: Critical Care: Sepsis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: To determine if specific comorbidities or number of comorbidities are associated with mortality, ICU admission rates, hospital length of stay, or hospital readmission rates.

METHODS: We performed a retrospective analysis of patients with severe sepsis/septic shock between 3/1/07 - 10/1/14. Additional inclusion criteria were: ≥18 years of age, admission through the Emergency Department, diagnosis of infection, antimicrobial administration, and organ dysfunction (increased lactate or ≥ 2 organ dysfunctions identified by ICD9 code or by lab values). Comorbidities were identified and queried based on those defined by the University Health System Consortium. Data were analyzed according to their specific comorbidities.

RESULTS: There were 7071 cases of severe sepsis/septic shock, 3400 (48%) women and 3671 (52%) men, aged 59.7 ± 16.1 (mean ± SD) years. Overall mortality was 7.0%, while septic shock mortality was 20.9%. Among these patients, the average number of comorbidities was 4.28 ± 2.0. The most common documented comorbidity was hypertension (56.2% of encounters) and the least common was peptic ulcer disease (0.04%). Mortality for patients with no comorbidities was 2.4%. Metastatic cancer was associated with the highest mortality (17.4%). Between patients with 0 and 1-3 comorbidities, no significant difference was seen in mortality. However, among patients with ≥4 comorbidites, the odds of death was elevated with each increase in number of comorbidities (4 (OR=3.48, 95% CI:1.09-11.1) or ≥5 (OR=3.5, 95% CI:1.10-11.0). Among patients with ≥4 comorbidites, the odds of being readmitted within 30 days was higher than those without without any comorbidites (OR=1.6, 95% CI:1.008-2.54).

CONCLUSIONS: There is a positive correlation between the number of comorbidities and mortality in patients with severe sepsis/septic shock when 4 or more comorbidities are present. ICU admission rates and 30-day readmission rates were also higher in patients with increased numbers of comorbidities.

CLINICAL IMPLICATIONS: Identification of pre-existing comorbidities at the time of admission for severe sepsis/septic shock should allow providers to give more accurate prognostic information to patients and families. It is possible that identifying these comorbidities at the time of diagnosing severe sepsis may prompt earlier and more aggressive intervention. Further prospective studies are required to determine whether such interventions impact mortality in the face of multiple comorbidities.

DISCLOSURE: The following authors have nothing to disclose: Bristol Whiles, Amanda Deis, Patrick Miller, Steven Simpson

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