Cardiovascular Events Among Survivors of Sepsis Hospitalization: A Retrospective Cohort Analysis.
Cardiovascular Events Among Survivors of Sepsis Hospitalization: A Retrospective Cohort Analysis.
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DOI：
10.1161/jaha.122.027813
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发表时间：
2023-02-07
影响因子：
5.4
通讯作者：
Dunlay, Shannon M.
中科院分区：
文献类型：
--
作者：
Jentzer, Jacob C.;Lawler, Patrick R.;Van Houten, Holly K.;Yao, Xiaoxi;Kashani, Kianoush B.;Dunlay, Shannon M.
败血症与医院幸存者晚期心血管事件的风险增加有关。我们纳入了从2009年到2019年OptomLabs Data Warehouse的患者，他们在内科/非手术住院至少两晚后幸存下来。采用Kaplan-Meier生存分析和多变量Cox比例风险模型分析住院期间脓毒症(基于显性和隐性出院的国际疾病分类第九版(ICD-9)/第十版(ICD-10)诊断代码)与后续死亡和再住院的关系。研究人群包括2， 258， ，464名非手术住院的幸存者(5， ，396， ，051患者--总的随访年数)。共有808例 673(35.8%)患者有脓毒症住院经历，其中448例 644例为隐性脓毒症，124例 841例为显性败血症，235例 188例两者皆有。住院期间患有败血症的患者全因死亡率(调整后的危险比[HR]，1.27[95%CI，1.25-1.28]；P<；0.001)、全原因再住院(调整后HR，1.38[95%CI，1.37-1.39]；P<；0.001)和心血管住院(调整后HR，1.43[95%CI，1.41-1.44]；P<；0.001)，尤其是心力衰竭住院(调整后的HR，1.5[95%CI，1.49~1.53])。隐匿性脓毒症患者的风险高于外显性脓毒症患者。使用首次住院的敏感性分析得出了与心血管住院一致的结果(调整后的HR，1.78[95%CI，1.76-1.78]；P<；0.001)，以及倾向加权分析(调整后的HR，1.5[95%CI，1.5-1.54]；P<；0.001)。败血症住院的幸存者出院后早期和晚期死亡以及心血管和非心血管再住院的风险较高。这种危险跨越了心血管事件的范围，并可能表明脓毒症是一个重要的心血管危险因素。
Sepsis is associated with an elevated risk of late cardiovascular events among hospital survivors. We included OptumLabs Data Warehouse patients from 2009 to 2019 who survived a medical/nonsurgical hospitalization lasting at least 2 nights. The association between sepsis during hospitalization, based on explicit and implicit discharge International Classification of Diseases, Ninth Revision (ICD‐9)/Tenth Revision (ICD‐10) diagnosis codes, with subsequent death and rehospitalization was analyzed using Kaplan–Meier survival analysis and multivariable Cox proportional‐hazards models. The study population included 2 258 464 survivors of nonsurgical hospitalization (5 396 051 total patient‐years of follow‐up). A total of 808 673 (35.8%) patients had a sepsis hospitalization, including implicit sepsis only in 448 644, explicit sepsis only in 124 841, and both in 235 188. Patients with sepsis during hospitalization had an elevated risk of all‐cause mortality (adjusted hazard ratio [HR], 1.27 [95% CI, 1.25–1.28]; P<0.001), all‐cause rehospitalization (adjusted HR, 1.38 [95% CI, 1.37–1.39]; P<0.001), and cardiovascular hospitalization (adjusted HR, 1.43 [95% CI, 1.41–1.44]; P<0.001), especially heart failure hospitalization (adjusted HR, 1.51 [95% CI, 1.49–1.53]). Patients with implicit sepsis had higher risk than those with explicit sepsis. A sensitivity analysis using the first hospitalization yielded concordant results for cardiovascular hospitalization (adjusted HR, 1.78 [95% CI, 1.76–1.78]; P<0.001), as did a propensity‐weighted analysis (adjusted HR, 1.52 [95% CI, 1.50–1.54]; P<0.001). Survivors of sepsis hospitalization are at elevated risk of early and late post‐discharge death as well as cardiovascular and non‐cardiovascular rehospitalization. This hazard spans the spectrum of cardiovascular events and may suggest that sepsis is an important cardiovascular risk factor.