TY - JOUR
T1 - Sepsis outcomes in solid organ transplant recipients
AU - Gotur, Deepa B.
AU - Masud, Faisal N.
AU - Ezeana, Chika F.
AU - Nisar, Tariq
AU - Paranilam, Jaya
AU - Chen, Shenyi
AU - Puppala, Mamta
AU - Wong, Stephen T.
AU - Zimmerman, Janice L.
N1 - Funding Information:
This study is partly supported by Ting Tsung & Wei Fong Chao Foundation and John S Dunn Research Foundation supporting Dr Stephen TC Wong.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/2
Y1 - 2020/2
N2 - Background: We present data on a cohort of patients diagnosed with sepsis over a 10-year period comparing outcomes in solid organ transplant (SOT) and non–solid organ transplant (non–SOT) recipients. Methods: This is a retrospective single-center study of patients with diagnosis of sepsis from 1/1/06 to 6/30/16. Cases and controls were matched by year of sepsis diagnosis with propensity score matching. Conditional logistic regression and repeated measurement models were performed for binary outcomes. Trends over time for in-hospital mortality were determined using the Cochran-Armitage test. A gamma-distributed model was performed on the continuous variables. Results: Overall, there were 18 632 admission encounters with a discharge diagnosis of sepsis in 14 780 unique patients. Of those admissions, 1689 were SOT recipients. After 1:1 matching by year, there were three thousand three hundred and forty patients (1670 cases; 1670 controls) diagnosed with sepsis. There was a decreasing trend for in-hospital mortality for sepsis over time in SOT patients and non–SOT patients (P <.05) due to early sepsis recognition and improved standard of care. Despite higher comorbidities in the SOT group, conditional logistic regression showed that in-hospital mortality for sepsis in SOT patients was similar compared with non–SOT patients (odds ratio [OR] =1.14 [95% confidence interval {CI}, 0.95-1.37], P =.161). However, heart and lung SOT subgroups had higher odds of dying compared with the non–SOT group (OR = 1.83 [95% CI, 1.30-2.57], P <.001 and OR = 1.77 [95% CI, 1.34-2.34], P <.001). On average, SOT patients had 2 days longer hospital length of stay compared with non–SOT admissions (17.00 ± 19.54 vs 15.23 ± 17.07, P <.05). Additionally, SOT patients had higher odds of hospital readmission within 30 days (OR = 1.25 [95% CI, 1.06-1.51], P =.020), and higher odds for DIC compared with non–SOT patients (OR = 1.76 [95% CI, 1.10-2.86], P =.021). Conclusion: Sepsis in solid organ transplants and non–solid organ transplant patients have similar mortality; however, the subset of heart and lung transplant recipients with sepsis has a higher rate of mortality compared with the non–solid organ transplant recipients. SOT with sepsis as a group has a higher hospital readmission rate compared with non–transplant sepsis patients.
AB - Background: We present data on a cohort of patients diagnosed with sepsis over a 10-year period comparing outcomes in solid organ transplant (SOT) and non–solid organ transplant (non–SOT) recipients. Methods: This is a retrospective single-center study of patients with diagnosis of sepsis from 1/1/06 to 6/30/16. Cases and controls were matched by year of sepsis diagnosis with propensity score matching. Conditional logistic regression and repeated measurement models were performed for binary outcomes. Trends over time for in-hospital mortality were determined using the Cochran-Armitage test. A gamma-distributed model was performed on the continuous variables. Results: Overall, there were 18 632 admission encounters with a discharge diagnosis of sepsis in 14 780 unique patients. Of those admissions, 1689 were SOT recipients. After 1:1 matching by year, there were three thousand three hundred and forty patients (1670 cases; 1670 controls) diagnosed with sepsis. There was a decreasing trend for in-hospital mortality for sepsis over time in SOT patients and non–SOT patients (P <.05) due to early sepsis recognition and improved standard of care. Despite higher comorbidities in the SOT group, conditional logistic regression showed that in-hospital mortality for sepsis in SOT patients was similar compared with non–SOT patients (odds ratio [OR] =1.14 [95% confidence interval {CI}, 0.95-1.37], P =.161). However, heart and lung SOT subgroups had higher odds of dying compared with the non–SOT group (OR = 1.83 [95% CI, 1.30-2.57], P <.001 and OR = 1.77 [95% CI, 1.34-2.34], P <.001). On average, SOT patients had 2 days longer hospital length of stay compared with non–SOT admissions (17.00 ± 19.54 vs 15.23 ± 17.07, P <.05). Additionally, SOT patients had higher odds of hospital readmission within 30 days (OR = 1.25 [95% CI, 1.06-1.51], P =.020), and higher odds for DIC compared with non–SOT patients (OR = 1.76 [95% CI, 1.10-2.86], P =.021). Conclusion: Sepsis in solid organ transplants and non–solid organ transplant patients have similar mortality; however, the subset of heart and lung transplant recipients with sepsis has a higher rate of mortality compared with the non–solid organ transplant recipients. SOT with sepsis as a group has a higher hospital readmission rate compared with non–transplant sepsis patients.
KW - acute kidney injury
KW - and sepsis-induced acute respiratory distress syndrome
KW - disseminated intravascular coagulation
KW - organ dysfunction
KW - sepsis
KW - septic shock
KW - severe sepsis
KW - solid organ transplant
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U2 - 10.1111/tid.13214
DO - 10.1111/tid.13214
M3 - Article
C2 - 31755202
AN - SCOPUS:85076121157
VL - 22
SP - e13214
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
SN - 1398-2273
IS - 1
M1 - e13214
ER -