Sepsis outcomes in solid organ transplant recipients

Research output: Contribution to journalArticle

Deepa B. Gotur, Faisal N. Masud, Chika F. Ezeana, Tariq Nisar, Jaya Paranilam, Shenyi Chen, Mamta Puppala, Stephen T. Wong, Janice L. Zimmerman

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.

Original languageEnglish (US)
Article numbere13214
JournalTransplant Infectious Disease
Volume22
Issue number1
DOIs
StatePublished - Nov 21 2019

PMID: 31755202

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Sepsis outcomes in solid organ transplant recipients. / Gotur, Deepa B.; Masud, Faisal N.; Ezeana, Chika F.; Nisar, Tariq; Paranilam, Jaya; Chen, Shenyi; Puppala, Mamta; Wong, Stephen T.; Zimmerman, Janice L.

In: Transplant Infectious Disease, Vol. 22, No. 1, e13214, 21.11.2019.

Research output: Contribution to journalArticle

Harvard

Gotur, DB, Masud, FN, Ezeana, CF, Nisar, T, Paranilam, J, Chen, S, Puppala, M, Wong, ST & Zimmerman, JL 2019, 'Sepsis outcomes in solid organ transplant recipients' Transplant Infectious Disease, vol. 22, no. 1, e13214. https://doi.org/10.1111/tid.13214

APA

Gotur, D. B., Masud, F. N., Ezeana, C. F., Nisar, T., Paranilam, J., Chen, S., ... Zimmerman, J. L. (2019). Sepsis outcomes in solid organ transplant recipients. Transplant Infectious Disease, 22(1), [e13214]. https://doi.org/10.1111/tid.13214

Vancouver

Gotur DB, Masud FN, Ezeana CF, Nisar T, Paranilam J, Chen S et al. Sepsis outcomes in solid organ transplant recipients. Transplant Infectious Disease. 2019 Nov 21;22(1). e13214. https://doi.org/10.1111/tid.13214

Author

Gotur, Deepa B. ; Masud, Faisal N. ; Ezeana, Chika F. ; Nisar, Tariq ; Paranilam, Jaya ; Chen, Shenyi ; Puppala, Mamta ; Wong, Stephen T. ; Zimmerman, Janice L. / Sepsis outcomes in solid organ transplant recipients. In: Transplant Infectious Disease. 2019 ; Vol. 22, No. 1.

BibTeX

@article{b21a1bea46474b11940b2ef060f602d1,
title = "Sepsis outcomes in solid organ transplant recipients",
abstract = "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.",
keywords = "acute kidney injury, and sepsis-induced acute respiratory distress syndrome, disseminated intravascular coagulation, organ dysfunction, sepsis, septic shock, severe sepsis, solid organ transplant",
author = "Gotur, {Deepa B.} and Masud, {Faisal N.} and Ezeana, {Chika F.} and Tariq Nisar and Jaya Paranilam and Shenyi Chen and Mamta Puppala and Wong, {Stephen T.} and Zimmerman, {Janice L.}",
year = "2019",
month = "11",
day = "21",
doi = "10.1111/tid.13214",
language = "English (US)",
volume = "22",
journal = "Transplant Infectious Disease",
issn = "1398-2273",
publisher = "Wiley",
number = "1",

}

RIS

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.

PY - 2019/11/21

Y1 - 2019/11/21

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

UR - http://www.scopus.com/inward/record.url?scp=85076121157&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076121157&partnerID=8YFLogxK

U2 - 10.1111/tid.13214

DO - 10.1111/tid.13214

M3 - Article

VL - 22

JO - Transplant Infectious Disease

T2 - Transplant Infectious Disease

JF - Transplant Infectious Disease

SN - 1398-2273

IS - 1

M1 - e13214

ER -

ID: 56314076