John Garza, PhD
Assistant Professor
University of Texas Permian Basin, United States
Disclosure information not submitted.
Hina Tariq, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Thao Dang, MD
Resident, Internal Medicine
n/a
Odessa, Texas, United States
Disclosure information not submitted.
Neha Panchagnula
Texas Tech University Health Sciences Center at the Permian Basin
Odessa, Texas
Disclosure information not submitted.
Lavi Oud, MD
Professor
Texas Tech University Health Sciences Center
Odessa, Texas, United States
Disclosure information not submitted.
Title: End-Stage Renal Disease and Risk of Short-Term Mortality in Sepsis
Introduction: The risk of sepsis hospitalizations is over 40-fold higher in patients with end-stage renal disease (ESRD) compared to the general population. However, reports on the prognostic impact of ESRD in sepsis described mixed findings, are mostly dated, and the temporal trends of short-term outcomes of septic patients with ESRD are unknown. We sought to examine the association of ESRD with short-term mortality in sepsis and to compare outcome trajectories among those with and without ESRD.
Methods: We used the Texas Public Use Data File to identify hospitalizations aged ≥18 years with sepsis during 2014-2017. Sepsis was defined by “explicit” ICD-9 and ICD-10 codes for severe sepsis (995.92, R65.20) and septic shock (785.52, R65.21). ESRD was identified using ICD-9 and ICD-10 codes 585.6 & N186. Multilevel multivariable logistic regression was used to model the association of ESRD with short-term mortality (defined as in-hospital death or discharge to hospice) among sepsis hospitalizations. Similar approach was used to examine the temporal trends of short-term mortality among sepsis hospitalizations with and without ESRD and for sensitivity analyses restricted to ICU admissions and those with septic shock.
Results: Among 283,025 sepsis hospitalizations, 26,966 (9.5%) had ESRD. Compared to those without ESRD, ESRD hospitalizations were younger (age ≥65 years, 49.6% vs 57.4%), more commonly racial minority (68.7% vs. 45.8%) and with higher mean [SD] number of failing organs (2.7 [1.5] vs. 2.6 [1.5]) [p< 0.0001 for all comparisons]. The unadjusted short-term mortality among hospitalizations with vs without ESRD was 37.5% vs 30.6%, respectively. On adjusted analyses, ESRD remained associated with higher risk of short-term mortality (adjusted odds ratio [aOR] 1.57 [95% CI 1.51-1.62]). The findings on sensitivity analyses were consistent with those of the primary model. Short-term mortality among sepsis hospitalizations decreased over time among those with ESRD (aOR 0.95/year [95% CI 0.92-0.97]) and those without ESRD (aOR 0.97/year [95% CI 0.95-0.97]).
Conclusions: ESRD is associated with markedly higher risk of short-term mortality in sepsis. However, sepsis outcomes in ESRD have improved overtime. Further studies are needed to examine approaches to improve the outcomes of septic ESRD patients.