Hospital-Acquired Sepsis Linked to Higher Rates of Multiple Complications

Teresa Padro, RN, BSN, CEN

Patients with hospital-acquired sepsis have a higher prevalence of both congestive heart failure and cerebrovascular disease, an increased need for mechanical ventilation and vasopressors, increased length of stay, more days in the intensive care unit, and higher mortality compared to those with community-acquired sepsis.

Data presented at the Society of Critical Care Medicine’s 47th Critical Care Conference in San Antonio, Texas, showed that when comparing hospital-acquired with community-acquired sepsis patients, the former was more associated with myriad complications. The investigators also found that moderate-to-severe liver disease was “an independent predictor of death from hospital-acquired sepsis.” Those with both conditions were more likely to die than those without liver disease (odds ratio [OR], 3.38; 95% CI, 1.64-6.96).

Led by Teresa Padro, RN, BSN, CEN, a member of the University of Florida’s UF Health Emergency Department, the team conducted a retrospective univariate and multivariable analysis of 3197 patients 18 years and older that were admitted for sepsis and compared instances for those with the community-acquired sepsis group (CA; n = 3186) and hospital-acquired sepsis group (HA; n = 731).

Demographically, in the CA group, 51% of patients (n = 1629) were female compared to 44% (n = 322) in the HA group (P <.001), while the sepsis occurred in more white patients in the HA group (49%; n = 356) than the CA group (43%; n = 1371; P = .009).

“The HA group also had a 3.2 times higher [intensive care unit length of stay] than CA patients at 9 days and 2.8 days respectively, (P < 0.0001); and the mean overall LOS was 2 times higher in the HA than the CA group at 23.1 days and 11.2 days, respectively (P < 0.0001),” Padro and colleagues wrote.

Congestive heart failure and cerebrovascular disease occurred at higher rates in the HA group, with incidence rates of 24% (n = 177) and 11% (n = 83) of the HA group, respectively, compared to 21% (n = 668; P =.055) for heart failure and 8% (n = 258; P = .005) for cerebrovascular disease in the CA group.

Additionally, those in the HA group were 3% more likely to have a history of myocardial infarction (10%; n = 70) compared to the CA group (7%; n = 213; P = .007).

With regards to the need for mechanical ventilation, those in the HA group were thrice as likely as the CA group have that necessity (21% vs. 7%; P <.001). Vasopressors were utilized by 334 patients in the HA group (46%) compared to 832 in the CA group (26%; P <.001).

“In this retrospective analysis, HA-sepsis patients had a higher prevalence of CHF and CVD, increased requirement for mechanical ventilation and vasopressors, and increased LOS, ICU days, and mortality compared to CA-sepsis,” the authors concluded.

The study, “Hospital-Acquired Sepsis, a Descriptive Study and Comparison to Community-Acquired Sepsis,” was published in Critical Care Medicine.