Image showing bacteria next to blood cells in a blood vessel to illustrate what happens prior to sepsis setting in
Credit: Dr_Microbe/Getty Images

Patients treated for sepsis during hospital stays were at much greater risk of cardiovascular events and rehospitalization for any cause, or death, for as long as 12 years after, according to a study published today in the Journal of the American Heart Association. The study looked at claims data for approximately 2.3 million patients.

An accompanying editorial, (Wardi et al.), describes this work as: “The largest study to date evaluating the association between sepsis and postdischarge adverse events, specifically highlighting cardiovascular complications with more than a decade of nationwide follow‐up data.”

Sepsis is a leading cause of hospitalization and death worldwide. Each year in the U.S., about 1.7 million people develop this condition, which is an extreme immune response to an infection in the bloodstream. Sepsis can spread throughout the whole body causing organ failure and possibly death. It is known that it can affect the heart, but it was not recognized how strong that link was.

“Our findings indicate that after hospitalization with sepsis, close follow-up care is important, and it may be valuable to implement cardiovascular prevention therapies with close supervision,” said lead study author, Jacob C. Jentzer, MD, an assistant professor of medicine in the department of cardiovascular medicine at the Mayo Clinic in Rochester, Minnesota.

“Professionals need to be aware that people who have previously had sepsis are at very high risk for cardiovascular events, and that it may be necessary to advise them to increase the intensity of their cardiovascular prevention,” he added.

Claims data highlights link

The researchers queried a database of administrative claims data and identified more than 2 million enrollees of commercial and Medicare Advantage insurance across the U.S. who survived a non-surgical hospitalization of two nights or more between 2009 and 2019. Of these patients, who were 19-87 years old, more than 800,000 had sepsis during their hospital stay. The researchers then looked at rehospitalization and death rates over a follow-up period from 2009 to 2021.

These researchers compared 808,673 hospitalized patients who had sepsis to 1,449,821 hospitalized patients who did not but still had cardiovascular disease or one or more cardiovascular disease risk factors (older age, hypertension, hyperlipidemia, type 2 diabetes, chronic kidney disease, obesity or smoking).

Because there are variations in sepsis diagnosis and documentation, the team used two standard diagnosis codes for sepsis: explicit and implicit. Explicit sepsis means a physician formally diagnosed the patient. Implicit sepsis is an administrative code in the electronic health record assigned automatically when a patient has both an infection and organ failure. Much work is ongoing to find better biomarkers of sepsis.

This teams analysis found:

  • In the 12 years after having sepsis, patients were 27% more likely to die, 38% more likely to be rehospitalized for any cause and 43% more likely to return to the hospital specifically for cardiovascular causes.
  • Heart failure was the most common major cardiovascular event (including stroke, heart attack, arrhythmia and heart failure) among people who had been treated for sepsis. These patients had a 51% higher risk of developing heart failure during the follow-up period.
  • Patients with implicit sepsis (infection with organ failure) had a two-fold increased risk of rehospitalization for cardiovascular events compared to those with explicit sepsis (formal diagnosis by a physician).

“We know that infection may be a potential trigger for myocardial infarction or heart attack, and infection may also predispose a patient to other cardiovascular events, either directly during infection or later when the infection and related effects on the body promote progressive cardiovascular disease,” said Jentzer.

The authors are now looking at cardiovascular prevention therapies that could help these patients. “It’s an important opportunity to establish what might and might not work in the future for people who have had sepsis,” Jentzer said.

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