Edith T Robin, MD
Physician, Department of Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Yasmin Herrera
Icahn School of Medicine at Mount Sinai
New York, NY
Disclosure information not submitted.
Maria Riego, MD
Resident, Department of Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Nobel Chowdhury, MD
Resident Physician, Department of Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Raymond A Jean, MD
Resident, Department of Surgery
Yale University, United States
Disclosure information not submitted.
Raymonde Jean, MD
Associate Professor, Department of Critical Care and Pulmonary Medicine
Icahn School of Medicine at Mount Sinai, United States
Disclosure information not submitted.
Title: Impact of SEPSIS-3 Guidelines on Sepsis Mortality in the United States
Introduction:
Sepsis remains one of the most common causes of inpatient mortality, although rates have significantly declined since the release of Surviving Sepsis Campaign (SSC) guidelines in 2004. In the fall of 2016, the SEPSIS-3 guidelines were released, aiming to simplify the definition and facilitate earlier recognition and timely management of sepsis. Several studies have since validated the use of SOFA score to predict unfavorable outcomes and limit misclassification into a lower severity. Few studies, however, have investigated how the guideline changes since 2016 impacted inpatient sepsis mortality rates.
Methods:
The Nationwide Inpatient Sample (NIS) between 2014 and 2017 was queried for non-surgical admissions with a diagnosis of severe sepsis and septic shock. Patients admitted after the 3rd quarter (Q3) of 2016, corresponding to the release of the SEPSIS-3 guidelines, were stratified. Mortality trends were compared in the subsequent year to those from prior. An adjusted linear regression with an interaction term between time and the post-guideline period was used to approximate the mean change in the annual mortality.
Results:
A total of 9,081,993 admissions with a diagnosis of severe sepsis were identified during the study period, of whom 3,159,143 were after the release of the SEPSIS-3 guidelines. Between 2014 and the Q3 2016, there was a trend towards declining inpatient mortality ( 14.8% in Q1 2014 vs. 11.0% in Q3 2016). This trend generally persisted, with the lowest average mortality of 10.4% in Q3 2017. In an adjusted linear model, there was a significant annual mortality reduction of 0.73% (p< 0.0001). The rate of decline in mortality slightly increased after the SEPSIS-3 guidelines. However, this was not statistically significant (estimate 0.21% per year, p=0.30).
Conclusion:
The inpatient mortality rate from sepsis and septic shock showed a steady decline between 2014 and 2017 from 14.8% in Q1 2014 to 10.4% in Q3 2017. Despite the change in sepsis guidelines in Q3 2016, the rate of this mortality decline did not change significantly. This suggests that SEPSIS-3 guidelines may not be clinically associated with earlier recognition and intervention influencing mortality. However, more studies are needed to assess trends after 2017 as SEPSIS-3 guidelines were more widely adopted and utilized.