Hallie C Prescott1,2,3, Alicia G Carmichael4, Kenneth M Langa1,2,3,4, Richard Gonzalez4, Theodore J Iwashyna1,2,3,4. 1. 1 Department of Internal Medicine and. 2. 2 Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, Michigan. 3. 3 VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, Michigan; and. 4. 4 Institute for Social Research, Ann Arbor, Michigan.
Abstract
RATIONALE: Sepsis is a leading cause of death and disability whose heterogeneity is often cited as a key impediment to translational progress. OBJECTIVES: To test the hypothesis that there are consequential and significant differences in sepsis outcomes that result from differences in a patient's clinical course leading up to sepsis hospitalization. METHODS: We conducted an observational cohort study of U.S. Health and Retirement Study (HRS) participants in Medicare (1998-2012) and U.S. Department of Veterans Affairs beneficiaries (2009). Using latent profile analysis, we identified patient subtypes based on trajectory of presepsis healthcare facility use. Subtypes were identified in the derivation cohort (1,512 sepsis hospitalizations among earlier HRS participants), then validated them in two additional cohorts (1,992 sepsis hospitalizations among later HRS participants; 32,525 sepsis hospitalizations among U.S. Department of Veterans Affairs beneficiaries). We measured the association between presepsis path and 90-day mortality using chi-square tests and multivariable logistic regression. RESULTS: We identified three subtypes: low use of inpatient healthcare facilities, comprising 84% of the derivation cohort; rising use, 12%; and high use, 4%. The shape and distribution of presepsis trajectories were similar in all three cohorts. In the derivation cohort, 90-day mortality differed by presepsis trajectory as follows: 38% (low use), 63% (rising use), and 48% (high use) (P < 0.001). This association persisted in the validation cohorts (P < 0.001 for each). The rising use class remained an independent predictor of mortality after adjustment for potential confounders, including detailed physiologic data. CONCLUSIONS: In national cohorts of patients with sepsis, we have shown that several distinct paths into sepsis exist. These paths, identified by trajectories of presepsis healthcare use, are predictive of 90-day mortality.
RATIONALE: Sepsis is a leading cause of death and disability whose heterogeneity is often cited as a key impediment to translational progress. OBJECTIVES: To test the hypothesis that there are consequential and significant differences in sepsis outcomes that result from differences in a patient's clinical course leading up to sepsis hospitalization. METHODS: We conducted an observational cohort study of U.S. Health and Retirement Study (HRS) participants in Medicare (1998-2012) and U.S. Department of Veterans Affairs beneficiaries (2009). Using latent profile analysis, we identified patient subtypes based on trajectory of presepsis healthcare facility use. Subtypes were identified in the derivation cohort (1,512 sepsis hospitalizations among earlier HRSparticipants), then validated them in two additional cohorts (1,992 sepsis hospitalizations among later HRSparticipants; 32,525 sepsis hospitalizations among U.S. Department of Veterans Affairs beneficiaries). We measured the association between presepsis path and 90-day mortality using chi-square tests and multivariable logistic regression. RESULTS: We identified three subtypes: low use of inpatient healthcare facilities, comprising 84% of the derivation cohort; rising use, 12%; and high use, 4%. The shape and distribution of presepsis trajectories were similar in all three cohorts. In the derivation cohort, 90-day mortality differed by presepsis trajectory as follows: 38% (low use), 63% (rising use), and 48% (high use) (P < 0.001). This association persisted in the validation cohorts (P < 0.001 for each). The rising use class remained an independent predictor of mortality after adjustment for potential confounders, including detailed physiologic data. CONCLUSIONS: In national cohorts of patients with sepsis, we have shown that several distinct paths into sepsis exist. These paths, identified by trajectories of presepsis healthcare use, are predictive of 90-day mortality.
Authors: Amanda Sonnega; Jessica D Faul; Mary Beth Ofstedal; Kenneth M Langa; John W R Phillips; David R Weir Journal: Int J Epidemiol Date: 2014-03-25 Impact factor: 7.196
Authors: Hector R Wong; Natalie Cvijanovich; Richard Lin; Geoffrey L Allen; Neal J Thomas; Douglas F Willson; Robert J Freishtat; Nick Anas; Keith Meyer; Paul A Checchia; Marie Monaco; Kelli Odom; Thomas P Shanley Journal: BMC Med Date: 2009-07-22 Impact factor: 8.775
Authors: Emma E Davenport; Katie L Burnham; Jayachandran Radhakrishnan; Peter Humburg; Paula Hutton; Tara C Mills; Anna Rautanen; Anthony C Gordon; Christopher Garrard; Adrian V S Hill; Charles J Hinds; Julian C Knight Journal: Lancet Respir Med Date: 2016-02-23 Impact factor: 102.642
Authors: Hallie C Prescott; Theodore J Iwashyna; Bronagh Blackwood; Thierry Calandra; Linda L Chlan; Karen Choong; Bronwen Connolly; Paul Dark; Luigi Ferrucci; Simon Finfer; Timothy D Girard; Carol Hodgson; Ramona O Hopkins; Catherine L Hough; James C Jackson; Flavia R Machado; John C Marshall; Cheryl Misak; Dale M Needham; Pinaki Panigrahi; Konrad Reinhart; Sachin Yende; Ross Zafonte; Kathryn M Rowan; Derek C Angus Journal: Am J Respir Crit Care Med Date: 2019-10-15 Impact factor: 21.405
Authors: Alexander H Flannery; Chad M Venn; Amanda Gusovsky; Stephanie Henderson; Adam S Kiser; Hallie C Prescott; Chanu Rhee; Chris Delcher; Peter E Morris Journal: Crit Care Explor Date: 2022-02-04