Sepsis Among Hospitalized Patients: Events in the 30 Days Preceding the Diagnosis

TL;DR

This study examines healthcare encounters and diagnostic results in the 30 days before sepsis diagnosis, finding that more encounters and abnormal tests are linked to higher mortality.

Contribution

The study identifies patterns in healthcare encounters and diagnostic results preceding sepsis diagnosis, linking them to patient outcomes.

Findings

36% of patients had healthcare encounters in the 30 days before sepsis diagnosis.

Patients with more encounters had higher mortality rates.

Older patients were more likely to be transferred to extended care facilities.

Abstract

Introduction

Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection, and is one of the leading causes of morbidity and mortality globally. This study was undertaken to investigate the role of healthcare encounters and diagnostic test results in the 30 days preceding a sepsis diagnosis.

Methods

In this single-center retrospective chart review, eligible subjects were 18 years of age and older who presented to the ED and were diagnosed with either sepsis or septic shock in the ED or inpatient setting between January 2020 and September 2023. Healthcare encounters such as laboratory and diagnostic studies obtained within 30 days prior to the diagnosis of sepsis or septic shock were included in the analysis.

Results

A total of 363 ED patients with a diagnosis of sepsis were included in the study. The mean age of the patients was 64 years (range 18-99), with 47% being women. At ED presentation, 202 (66%) had an abnormal chest radiograph, and 224 (75%) had an abnormal EKG. Final disposition included discharge home from inpatient setting (n=171; 48%), deceased (n=63; 17.55%), and transfer to an extended care facility (ECF) or rehabilitation center (n=125; 34.82%). A substantial number had a healthcare encounter within the previous 30 days prior to the diagnosis of sepsis (n=131; 36%; range: 1-28). Types of healthcare encounters included ED visit (n=113; 31%), inpatient hospitalization (n=85; 23%), outpatient visit (n=77; 21%), ECF (n=5; 1.2%), and home health visit (n=2; 0.5%).

Patients with more encounters within 30 days had higher mortality (deceased patients had a mean of 4.6 visits (95%CI: 3.0, 6.1), and patients discharged home had a mean of 3.0 visits (95%CI (2.3, 3.6) (p = 0.03). Older patients were more likely to be transferred to an ECF/rehabilitation center than discharged home (mean age of patients transferred to ECF: 70.9, 95%CI 68.4, 73.4; mean age of patients discharged home: 58.6, 95%CI 55.7, 61.5; p<0.0001).

Conclusions

Patients with a diagnosis of sepsis frequently had one or more healthcare encounters and diagnostic tests within 30 days prior to the diagnosis. Abnormal diagnostic tests, including creatinine, bilirubin, and alkaline phosphatase, were associated with higher mortality. Patients with more healthcare encounters and older patients had higher mortality.