Daily Sepsis Research Analysis

OBJECTIVES: Among adult sepsis survivors we aimed to: (i) assess the rate of all-cause, sepsis or infection hospital readmissions, and (ii) identify associated risk factors. METHODS: Retrospective cohort study of adult sepsis survivors with an index hospital admission between Jan 1, 2015, and Jan 31, 2021, in any hospital in New South Wales, Australia. The primary outcome was all-cause, sepsis or infection readmission through the emergency department (ED) within 30 days. Secondary outcomes were 7- and 90-day readmissions. Risk factors were investigated using multivariable logistic regression modelling. RESULTS: Within 30 days, 18,731 (14.9%) of the 125,370 adult sepsis survivors had an all-cause readmission through the ED. Of these readmissions, 1910 (10.2%) had a sepsis diagnosis and 4790 (25.6%) had an infection diagnosis. Factors associated with a higher risk of sepsis or infection-related readmission within 30 days were male sex, not being married, and chronic pulmonary disease, liver disease, diabetes, renal disease, malignancies, or malignant tumour comorbidities. In contrast, factors associated with a lower risk of sepsis or infection-related readmission were being aged 16-44 years (compared to survivors aged >85 years), living in inner regional areas (compared to major cities), or living in the least socioeconomically disadvantaged area (compared to the most), and myocardial infarction, cerebrovascular disease, or peptic ulcer disease comorbidities. CONCLUSION: Early and unexpected hospital readmissions are common in Australian sepsis survivors with almost 15% returning to hospital through the ED within 30 days, a third of which were for another sepsis or infection event.

BACKGROUND: Sepsis survivors often face long-term cardiovascular complications, including major adverse cardiovascular events (MACE), potentially linked to septic cardiomyopathy. Left ventricular global longitudinal strain (LV GLS) is a sensitive marker of cardiac dysfunction and a predictor of adverse outcomes. This study aimed to evaluate whether cardiac dysfunction measured by LV GLS is an independent predictor of MACE in septic patients. METHODS: This multicenter retrospective open cohort study included 439 patients hospitalized with sepsis or septic shock between 2018 and 2022. LV systolic function was assessed using LV GLS and Left Ventricular Ejection Fraction (LVEF) within seven days of admission. Patients were followed until July 2024. Restricted cubic spline Cox regression models examined non-linear associations between LV GLS, LVEF, and MACE. Additionally, Cox regression models adjusted for demographics, comorbidities, laboratory values, and sepsis severity markers evaluated whether LV systolic dysfunction, defined as high LV GLS (> -16) or low LVEF, were predictors of MACE. RESULTS: During the study period, 439 septic patients were included, totaling 595 patient-years of follow-up. Among them, 254 experienced MACE. LV GLS exhibited a non-linear association with MACE, with values between -23 and - 16 associated with the lowest risk. High LV GLS was independently associated with MACE (unadjusted HR: 1.4 [95% CI: 1.07, 1.8; p = 0.01]; adjusted HR 1.38 [95% CI: 1.01, 1.9; p = 0.04]). In contrast, low LVEF was not associated with MACE (unadjusted HR 1.2 [95% CI: 0.9, 1.5; p = 0.2]; adjusted HR 1.03 [95% CI: 0.73, 1.45; p = 0.8]). CONCLUSIONS: LV GLS was an independent predictor of MACE in septic patients, whereas LVEF did not show a significant association. These findings suggest that LV GLS may be a valuable biomarker for long-term cardiovascular risk stratification in this population.

BACKGROUND: Sepsis-induced coagulopathy (SIC) is commonly observed in patients with sepsis and is correlated with an elevated risk of mortality. The objective of this study is to analyse the association between the lactate-to-albumin ratio (LAR) and the occurrence of SIC, as well as all-cause mortality. METHODS: From the MIMIC-IV3.1 database, patients with sepsis who fulfilled the inclusion criteria were selected. The relationship between LAR and SIC was assessed by constructing a multivariate logistic regression model and performing Restricted cubic spline (RCS) analysis. To evaluate the predictive ability of different biomarkers for SIC, we performed ROC curve analysis. Subgroup analysis verifies the robustness of the results. Additionally, Cox regression analysis was conducted to investigate the association between LAR and mortality. RESULTS: A total of 8,661 patients with sepsis were included in the final analysis, of whom 5,784 developed SIC. In the comprehensive logistic regression model, each additional unit of LAR increased the odds of SIC rather by 1.85 (OR, 2.85, 95% CI, 2.48-3.28; p < 0.001). The odds of SIC rather in the highest LAR group was significantly increased (T3 vs T1: OR, 3.57; 95% CI, 3.06-4.17; p < 0.001). The relationship between LAR levels and SIC incidence was found to be nonlinear and positive, as revealed by RCS analysis. ROC analysis indicated superior predictive performance of LAR (AUC = 0.71) compared to albumin (AUC = 0.61) or lactate (AUC = 0.69). Subgroup analysis indicates a stable relationship between LAR and SIC. Moreover, an increase in LAR was correlated with a heightened risk of mortality at both 28 days and 360 days (28-d HR, 1.15; 95% CI, 1.11-1.19; 360-d HR, 1.14; 95% CI, 1.11-1.18; all p < 0.001). CONCLUSIONS: Observational findings indicate that elevated early LAR levels may be associated with increased rates of SIC and all-cause mortality in patients with sepsis. However, further prospective studies are needed to validate these associations and assess their clinical utility.