Background
Methods
Data sources, definitions and study population
State sequence analysis (SSA) of sepsis care pathways
Descriptive statistics
Patient characteristics, index hospital stay and healthcare use
Cognitive, psychological and medical impairment post-sepsis
Results
Patient characteristics, sequels and healthcare use and cost of all sepsis survivors
All survivors | Cluster 1 | Cluster 2 | Cluster 3 | Cluster 4 | Cluster 5 | |
---|---|---|---|---|---|---|
Early death | Late death | Short-term rehabilitation | Long-term rehabilitation | Home | ||
N = 147,013 (100%) | N = 19,003 (12.9%) | N = 10,058 (6.8%) | N = 16,597 (11.3%) | N = 4865 (3.3%) | N = 96,490 (65.6%) | |
Patient characteristics, %a | ||||||
Sex | ||||||
Men | 57.1 | 59.0 | 60.0 | 53.8 | 62.2 | 56.7 |
Women | 42.9 | 41.1 | 40.0 | 46.2 | 37.8 | 43.3 |
Age, median [IQRa] | 70 [58–81] | 77 [65–85] | 75 [64–84] | 75 [64–83] | 64 [52–75] | 68 [55–79] |
16–30 | 4.0 | 0.5 | 0.8 | 2.1 | 6.7 | 5.2 |
31–45 | 7.0 | 2.3 | 3.1 | 3.9 | 9.9 | 8.8 |
46–55 | 9.9 | 6.2 | 6.9 | 7.5 | 13.9 | 11.2 |
56–65 | 18.7 | 16.0 | 17.9 | 15.2 | 22.7 | 19.6 |
66–75 | 22.1 | 21.6 | 22.6 | 22.3 | 22.8 | 22.1 |
76–85 | 24.8 | 30.0 | 28.8 | 32.3 | 17.8 | 22.5 |
> 85 | 13.5 | 23.4 | 19.8 | 16.8 | 6.3 | 10.6 |
Charlson, median [IQRa] | 2 [0–3] | 2 [2–6] | 2 [2–5] | 2 [0–3] | 2 [0–2] | 1 [0–2] |
0 | 36.2 | 16.4 | 17.4 | 34.8 | 31.0 | 42.6 |
1–2 | 36.4 | 34.1 | 37.0 | 39.2 | 44.8 | 35.9 |
3–4 | 14.3 | 18.0 | 19.2 | 17.1 | 15.7 | 12.5 |
≥ 5 | 13.0 | 31.5 | 26.4 | 8.9 | 8.6 | 8.9 |
Incident hospital stay characteristics, %a | ||||||
Length of stay (days), median [IQR2] | 16 [10–28] | 19 [11–31] | 17 [10–28] | 27 [17–43] | 38 [21–62] | 14 [9–23] |
< 7 | 12.0 | 10.3 | 10.3 | 3.3 | 3.6 | 14.5 |
7–30 | 66.2 | 63.7 | 67.8 | 54.4 | 35.0 | 70.1 |
31–90 | 20.1 | 24.2 | 20.4 | 38.7 | 49.9 | 14.5 |
> 90 | 1.7 | 2.0 | 1.5 | 3.7 | 11.5 | 0.9 |
ICUc admission | 56.8 | 44.2 | 47.4 | 72.6 | 79.7 | 56.4 |
Septic shock | 16.4 | 16.7 | 15.5 | 22.3 | 22.3 | 15.0 |
Hospital discharge | ||||||
Acute care | 15.4 | 21.1 | 12.9 | 25.8 | 28.5 | 12.1 |
Home | 63.2 | 49.7 | 67.1 | 12.8 | 14.0 | 76.6 |
Home care | 1.1 | 3.2 | 1.6 | 0.2 | 0.4 | 0.8 |
Long term care | 20.3 | 26.1 | 18.5 | 61.2 | 57.2 | 10.5 |
All survivors | Cluster 1 | Cluster 2 | Cluster 3 | Cluster 4 | Cluster 5 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Early death | Late death | Short-term rehabilitation | Long-term rehabilitation | Home | ||||||||
Hospitalization 1-year pre-sepsis | ||||||||||||
Inpatient hospitalization in acute care | ||||||||||||
Patients N % | 88,052 | 59.9 | 14,306 | 75.3 | 7503 | 74.6 | 9804 | 59.1 | 2579 | 53.0 | 53,860 | 55.8 |
Days, median [IQR]a | 14 [0–28] | 20 [2–26] | 19 [3–35] | 13 [0–28] | 16 [0–35] | 11 [0–24] | ||||||
Day care in acute care | ||||||||||||
Patients N % | 52,958 | 36.0 | 8911 | 46.9 | 4850 | 48.2 | 4663 | 28.1 | 1255 | 25.8 | 33,279 | 34.5 |
Days, median [IQR]a | 2 [1–8] | 5 [1–17] | 5 [1–15] | 1 [1–3] | 1 [1–3] | 2 [1–6] | ||||||
Inpatient hospitalization in rehabilitation | ||||||||||||
Patients N % | 17,304 | 11.8 | 3533 | 18.6 | 1592 | 15.8 | 3408 | 20.5 | 1033 | 21.2 | 7738 | 8.0 |
Days, median [IQR]a | 30 [3–70] | 33 [3–91] | 31 [3–60] | 36 [8–74] | 35 [8–89] | 29 [3–66] | ||||||
Day care in rehabilitation | ||||||||||||
Patients N % | 1669 | 1.1 | 158 | 0.8 | 95 | 0.9 | 239 | 1.4 | 98 | 2.0 | 1079 | 1.1 |
Days, median [IQR]a | 30 [18–55] | 32 [18–57] | 32 [19–57] | 31 [17–58] | 43 [22–85] | 29 [18–50] | ||||||
Hospital-at-home | ||||||||||||
Patients N % | 3236 | 2.2 | 1039 | 5.5 | 382 | 3.8 | 170 | 1.0 | 120 | 2.5 | 1525 | 1.6 |
Days, median [IQR]a | 32 [14–73] | 34 [13–73] | 29 [13–68] | 33 [15–65] | 30 [15–85] | 32 [14–76] | ||||||
Psychiatry | ||||||||||||
Patients N % | 3150 | 2.1 | 265 | 1.4 | 175 | 1.7 | 363 | 2.2 | 164 | 3.4 | 2183 | 2.3 |
Days, median [IQR]a | 37 [15–104] | 34 [13–94] | 42 [18–122] | 36 [18–81] | 45 [16–139] | 37 [15–106] | ||||||
Hospitalization 1-year post-sepsis | ||||||||||||
Inpatient hospitalization in acute care | ||||||||||||
Patients N % | 96,061 | 65.3 | 13,175 | 69.3 | 9042 | 89.9 | 11,904 | 71.7 | 3881 | 79.8 | 58,059 | 60.2 |
Days, median [IQR]a | 17 [0–35] | 16 [0–29] | 32 [9–57] | 21 [0–40] | 28 [3–57] | 14 [0–31] | ||||||
Day care in acute care | ||||||||||||
Patients N % | 52,948 | 36.0 | 4030 | 21.2 | 5030 | 50.0 | 5544 | 33.4 | 1822 | 37.5 | 36,522 | 37.9 |
Days, median [IQR]a | 2 [1–9] | 2 [1–5] | 5 [1–12] | 2 [1–7] | 2 [1–7] | 2 [1–10] | ||||||
Inpatient hospitalization in rehabilitation | ||||||||||||
Patients N % | 49,688 | 33.8 | 6355 | 33.4 | 3644 | 36.2 | 16,597 | 100 | 4865 | 100 | 18,227 | 18.9 |
Days, median [IQR]a | 35 [21–68] | 24 [11–43] | 40 [22–70] | 53 [37–76] | 177 [138–243] | 22 [16–29] | ||||||
Day care in rehabilitation | ||||||||||||
Patients N % | 5238 | 3.6 | 34 | 0.2 | 73 | 0.7 | 1502 | 9.1 | 1033 | 21.2 | 2596 | 2.7 |
Days, median [IQR]a | 43 [19–81] | 19 [8–34] | 32 [2–72] | 52 [26–88] | 73 [30–136] | 33 [16–60] | ||||||
Hospital-at-home | ||||||||||||
Patients N % | 11,356 | 7.7 | 2855 | 15.0 | 1732 | 17.2 | 837 | 5.0 | 459 | 9.4 | 5473 | 5.7 |
Days, median [IQR]a | 29 [12–69] | 19 [8–40] | 35 [12–97] | 41 [18 – 79] | 73 [32–145] | 32 [14–77] | ||||||
Psychiatry | ||||||||||||
Patients N % | 3168 | 2.2 | 81 | 0.4 | 120 | 1.2 | 390 | 2.4 | 146 | 3.0 | 2431 | 2.5 |
Days, median [IQR]a | 40 [17–108] | 19 [8–47] | 33 [13–113] | 42 [21–88] | 58 [21–171] | 41 [17–112] | ||||||
One-year mortality | 33,608 | 22.9 | 19,003 | 100 | 10,058 | 100 | 696 | 4.2 | 336 | 6.9 | 3515 | 3.6 |
No. days of survival b median [IQR] | 366 [365–366] | 37 [15–68] | 183 [144–228] | 366 [366–366] | 366 [366–366] | 366 [366–366] | ||||||
No. days at homeb median [IQR] | 328 [187–360] | 2 [0–23] | 113 [74–159] | 284 [247–310] | 108 [28–169] | 352 [328–365] |
Patient characteristics, sequels and healthcare use and cost according to sepsis survivor profiles
State sequence analyses: identification of sepsis survivor profiles
Characteristics of patients and their index hospital stays in each cluster
Comorbidities | All survivors | Cluster 1 | Cluster 2 | Cluster 3 | Cluster 4 | Cluster 5 |
---|---|---|---|---|---|---|
Heart failure (%) | 20.4 | 24.5 | 24.7 | 26.2 | 17.4 | 18.4 |
Dementia (%) | 5.3 | 10.3 | 8.6 | 4.8 | 2.9 | 4.2 |
Chronic pulmonary disease (%) | 11.9 | 12.1 | 13.3 | 13.2 | 9.2 | 11.6 |
Rheumatologic disease (%) | 1.3 | 1.2 | 1.0 | 1.6 | 1.5 | 1.3 |
Liver disease (%) | 5.5 | 6.0 | 6.4 | 5.2 | 4.6 | 5.4 |
Diabetes with chronic complications (%) | 6.4 | 6.5 | 6.8 | 7.7 | 10.7 | 6.0 |
Paraplegia and hemiplegia (%) | 5.2 | 5.8 | 4.1 | 9.4 | 29.4 | 3.3 |
Renal disease (%) | 12.6 | 15.5 | 15.7 | 13.1 | 11.2 | 11.6 |
Cancer (%) | 23.2 | 45.1 | 44.2 | 15.4 | 12.9 | 18.5 |
AIDS, HIV (%) | 0.5 | 0.3 | 0.4 | 0.5 | 0.8 | 0.6 |