Federico Angriman1,2,3, Laura C Rosella4,5,6,7, Patrick R Lawler8,9, Dennis T Ko5,10, Hannah Wunsch11,8,12,5, Damon C Scales11,8,12,5. 1. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. f.angriman@mail.utoronto.ca. 2. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. f.angriman@mail.utoronto.ca. 3. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. f.angriman@mail.utoronto.ca. 4. Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 5. ICES, Toronto, Canada. 6. Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada. 7. Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Toronto, ON, Canada. 8. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 9. Peter Munk Cardiac Centre, University Health Network, Toronto, Canada. 10. Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Canada. 11. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 12. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Abstract
PURPOSE: To determine whether surviving a first sepsis hospitalization is associated with long-term cardiovascular events. METHODS: Population-based matched cohort study conducted in Ontario, Canada (2008-2017). Adult survivors (older than 18 years) of a first sepsis hospitalization were matched to adult survivors of a non-sepsis hospitalization using hard-matching and propensity score methods. Patients with pre-existing cardiovascular disease were excluded. The primary composite outcome was myocardial infarction, stroke, or cardiovascular death up to 5 years of follow-up. Secondary outcomes included venous thromboembolism and all-cause death. Cox proportional hazards models with robust standard errors were used to estimate the association of sepsis with all outcomes of interest; hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Sensitivity analyses included Fine and Gray models to account for the competing risk of all-cause death and probabilistic bias analyses. RESULTS: 254,241 adult sepsis survivors were matched to adult survivors of non-sepsis hospitalization episodes. Sepsis survivors experienced an increased hazard of major cardiovascular events compared to non-sepsis survivors (HR 1.30; 95% CI 1.27-1.32), which was more pronounced in younger patients (HR 1.66; 95% CI 1.36-2.02 for patients aged 40 or younger; HR 1.21; 95% CI 1.18-1.24 for patients older than 80 years). Sepsis survivors also faced an increased hazard of venous thromboembolism (HR 1.61; 95% CI 1.55-1.67) and all-cause death (HR 1.26; 95% CI 1.25-1.27). Sensitivity analyses yielded consistent results. CONCLUSIONS: Adult sepsis survivors experience an increased hazard of major cardiovascular events compared to survivors of a non-sepsis hospitalization.
PURPOSE: To determine whether surviving a first sepsis hospitalization is associated with long-term cardiovascular events. METHODS: Population-based matched cohort study conducted in Ontario, Canada (2008-2017). Adult survivors (older than 18 years) of a first sepsis hospitalization were matched to adult survivors of a non-sepsis hospitalization using hard-matching and propensity score methods. Patients with pre-existing cardiovascular disease were excluded. The primary composite outcome was myocardial infarction, stroke, or cardiovascular death up to 5 years of follow-up. Secondary outcomes included venous thromboembolism and all-cause death. Cox proportional hazards models with robust standard errors were used to estimate the association of sepsis with all outcomes of interest; hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Sensitivity analyses included Fine and Gray models to account for the competing risk of all-cause death and probabilistic bias analyses. RESULTS: 254,241 adult sepsis survivors were matched to adult survivors of non-sepsis hospitalization episodes. Sepsis survivors experienced an increased hazard of major cardiovascular events compared to non-sepsis survivors (HR 1.30; 95% CI 1.27-1.32), which was more pronounced in younger patients (HR 1.66; 95% CI 1.36-2.02 for patients aged 40 or younger; HR 1.21; 95% CI 1.18-1.24 for patients older than 80 years). Sepsis survivors also faced an increased hazard of venous thromboembolism (HR 1.61; 95% CI 1.55-1.67) and all-cause death (HR 1.26; 95% CI 1.25-1.27). Sensitivity analyses yielded consistent results. CONCLUSIONS: Adult sepsis survivors experience an increased hazard of major cardiovascular events compared to survivors of a non-sepsis hospitalization.
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