Srinivasa Potla, MD
Resident Physician
Department of Medicine, Case Western Reserve University - MetroHealth, Ohio, United States
Disclosure information not submitted.
Ahmad Jabri, MD
Cardiology Fellow
Heart and Vascular Center, Case Western Reserve University - MetroHeath, Ohio, United States
Disclosure information not submitted.
Title: Demographic Undertones for Sepsis Mortality at a Community Hospital
INTRODUCTIONS: Sepsis is the body's overwhelming and life-threatening inflammatory response to an infection that can result in tissue damage, organ dysfunction, and death. Mortality resulting from severe sepsis and septic shock can be as high as 20-50%. Previous studies on the association of ethnicity and sepsis mortality have been inconclusive. Insurance status (of Medicaid, private, and uninsured patients) has been associated with higher sepsis-related mortality compared to Medicare patients. Studies also indicate that patients with a previously specified code status of Do Not Resuscitate (DNR) versus Full Code carry a higher mortality. This study was designed to determine the association of ethnicity, insurance type, and code status with sepsis-related mortality at Cleveland Clinic Akron General (CCAG).
Methods: Following approval by the CCAG IRB, a retrospective chart review of adult patients admitted with severe sepsis and septic shock over a one-year period was performed. The primary goal of the study was to investigate the relationship between ethnicity, insurance type and/or code status on sepsis in-hospital mortality and 30 to 90-day post-discharge mortality.
Results: A total of 915 patients met inclusion criteria, however 39 patients were excluded due to a missing outcome. In-hospital mortality was 11.7% (103/876), with an average age of 69 years among expiring patients and 62 among non-expiring patients (P < 0.0001). Code status on admission and discharge were significantly associated with hospital mortality. The results of a multiple logistic regression showed that patients who presented with a code status of DNR Comfort Care Arrest were 4.75 (95% CI 1.99-11.36, P=0.0007) times more likely to have died than Full Code patients. Those who had a code status change during the admission were 10.4 (95% CI 6.03-17.92, P < 0.0001) times more likely to have died compared to those who had no change. Insurance (including Medicare, Medicaid, private and uninsured) and race were not significantly associated with mortality.
Conclusions: Similar to previous studies, there was no observed association between ethnicity and sepsis mortality. Unlikely previous studies, insurance type was not associated with sepsis mortality. However, code status and change in code status were significantly associated with sepsis mortality.