Dataset Information

Incidence and associated risk factors for limb amputation among sepsis survivors in South Korea.

ABSTRACT:

Purpose

Peripheral gangrene (PG) is a known complication requiring limb amputation among sepsis survivors; however, its incidence and associated risk factors remain controversial. We aimed to examine the incidence of limb amputation among sepsis survivors, and to investigate factors independently associated with limb amputation.

Methods

In this population-based cohort study, data obtained from the South Korean national health insurance service database between 2015 and 2016 were analyzed. A sepsis survivor was defined as someone having survived > 90 days after initiation of treatment for sepsis.

Results

Of 19,906 sepsis survivors, 163 (0.8%) had undergone surgical limb amputation. In a multivariable model, male sex (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.26-2.40; P = 0.001), dopamine infusion (OR 1.78, 95% CI 1.22-2.60; P = 0.003), epinephrine infusion (OR 2.04, 95% CI 1.30-3.20; P = 0.002), continuous renal replacement therapy (OR 3.34, 95% CI 2.01-3.20; P < 0.001), diabetes mellitus (DM) without chronic complication (OR 1.73, 95% CI 1.19-2.51; P = 0.004), DM with chronic complication (OR 3.49, 95% CI 2.32-5.26; P < 0.001), and peripheral arterial disease (OR 6.79, 95% CO 3.70-12.46; P < 0.001) were associated with a higher incidence of limb amputation among sepsis survivors.

Conclusions

In South Korea, 0.8% of sepsis survivors underwent limb amputation for the treatment of PG. Furthermore, the incidence of limb amputation was higher among the sepsis survivors having some underlying diseases (DM and peripheral arterial diseases) or receiving certain vasopressor treatments (epinephrine and dopamine).

SUBMITTER: Oh TK

PROVIDER: S-EPMC7538278 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Incidence and associated risk factors for limb amputation among sepsis survivors in South Korea.

Oh Tak Kyu TK Song In-Ae IA

Journal of anesthesia 20201006 1

<h4>Purpose</h4>Peripheral gangrene (PG) is a known complication requiring limb amputation among sepsis survivors; however, its incidence and associated risk factors remain controversial. We aimed to examine the incidence of limb amputation among sepsis survivors, and to investigate factors independently associated with limb amputation.<h4>Methods</h4>In this population-based cohort study, data obtained from the South Korean national health insurance service database between 2015 and 2016 were a ...[more]

PMID: 33025150

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Project description:ImportanceSepsis survivors, defined as adult patients who survived to hospital discharge following a critical care unit admission for sepsis, are at increased risk of long-term mortality. Identifying factors independently associated with long-term mortality, known during critical care admission for sepsis, could inform targeted strategies to reduce this risk.ObjectiveTo assess, in adult sepsis survivors, factors independently associated with long-term mortality, known during their index critical care admission for sepsis, meeting Third International Consensus Definitions for Sepsis and Septic Shock criteria.Design, setting, and participantsThis cohort study included a nationally representative sample of 94 748 adult sepsis survivors from 192 critical care units in England. Participants were identified from consecutive critical care admissions between April 1, 2009, and March 31, 2014, with survival status ascertained as of March 31, 2015. Statistical analyses were completed in June 2017.ExposuresGeneric patient characteristics (age, sex, ethnicity, severe comorbidities [defined using the Acute Physiology and Chronic Health Evaluation II method], dependency, surgical status, and acute illness severity [scored using the Acute Physiology and Chronic Health Evaluation II acute physiology component]) and sepsis-specific patient characteristics (site of infection, number of organ dysfunctions, and septic shock status) known during index critical care admission for sepsis.Main outcomes and measuresLong-term mortality in adult sepsis survivors with maximum follow-up of 6 years. Adjusted hazard ratios (HRs) were estimated using Cox regression for both generic and sepsis-specific patient characteristics.ResultsSepsis survivors had a mean (SD) age of 61.3 (17.0) years, 43 584 (46.0%) were female, and 86 056 (90.8%) were white. A total of 46.3% had respiratory site of infection. By 1 year from hospital discharge, 15% of sepsis survivors had died, with 6% to 8% dying per year over the subsequent 5 years. Age, sex, race/ethnicity, severe comorbidities, dependency, nonsurgical status, and site of infection were independently associated with long-term mortality. Compared with single-organ dysfunction, having 2 or 3 organ dysfunctions was associated with increased risk of long-term mortality (adjusted HR, 1.07; 95% CI, 1.01-1.13; and adjusted HR, 1.18; 95% CI, 1.03-1.14, respectively), while having 4 organ dysfunctions or more was not associated with increased risk. Unexpectedly, the Acute Physiology and Chronic Health Evaluation acute physiology component score had an incremental association with long-term mortality (adjusted HR, 1.11 for every 5-point increase; 95% CI, 1.08-1.13). The adjusted HR for septic shock was 0.89 (95% CI, 0.85-0.92).Conclusions and relevanceThis study suggests that generic and sepsis-specific risk factors, known during index critical care admission for sepsis, could identify a high-risk sepsis survivor population for biological characterization and designing interventions to reduce long-term mortality.

Project description:To determine the frequency, mortality, cost, and risk factors associated with readmission after index hospitalization with severe sepsis.Observational cohort study of Healthcare Cost and Utilization Project data.All nonfederal hospitals in three U.S. states.Severe sepsis survivors (n = 43,452) in the first two quarters of 2011.None.We measured readmission rates and the associated cost and mortality of readmissions in severe sepsis survivors. We used multivariable logistic regression to identify patient and hospitalization characteristics associated with readmission. Of 43,452 sepsis survivors, 26% required readmission within 30 days and 48% within 180 days. The cumulative mortality rate of sepsis survivors attributed to readmissions was 8%, and the estimated cost was over $1.1 billion. Among survivors, 25% required multiple readmissions within 180 days and accounted for 77% of all readmissions. Age younger than 80 years (odds ratio, 1.14; 95% CI, 1.08-1.21), black race (odds ratio, 1.18; 95% CI, 1.10-1.26), and Medicare or Medicaid payor status (odds ratio, 1.21; 95% CI, 1.13-1.30; odds ratio, 1.34; 95% CI, 1.23-1.46, respectively) were associated with greater odds of 30-day readmission while female gender was associated with reduced odds (odds ratio, 0.92; 95% CI, 0.87-0.96). Comorbidities including malignancy (odds ratio, 1.34; 95% CI, 1.24-1.45), collagen vascular disease (odds ratio, 1.30; 95% CI, 1.15-1.46), chronic kidney disease (odds ratio, 1.24; 95% CI, 1.18-1.31), liver disease (odds ratio, 1.22; 95% CI, 1.11-1.34), congestive heart failure (odds ratio, 1.14; 95% CI, 1.08-1.19), lung disease (odds ratio, 1.12; 95% CI, 1.06-1.18), and diabetes (odds ratio, 1.12; 95% CI, 1.07-1.17) were associated with greater odds of 30-day readmission. Index hospitalization characteristics including longer length of stay, discharge to a care facility, higher hospital annual severe sepsis case volume, and higher hospital sepsis mortality rate were also positively associated with readmission rates.The 30-day and 180-day readmissions are common in sepsis survivors with significant resultant cost and mortality. Patient sociodemographics and comorbidities as well as index hospitalization characteristics are associated with 30-day readmission rates.

Dataset Information

Incidence and associated risk factors for limb amputation among sepsis survivors in South Korea.

Purpose

Methods

Results

Conclusions

Publications

Incidence and associated risk factors for limb amputation among sepsis survivors in South Korea.

Similar Datasets

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