Mortality in sepsis: Comparison of outcomes between patients with demand ischemia, acute myocardial infarction, and neither demand ischemia nor acute myocardial infarction

Mahek Shah, Soumya Patnaik, Obiora Maludum, Brijesh Patel, Byomesh Tripathi, Manyoo Agarwal, Lohit Garg, Sahil Agrawal, Ulrich P. Jorde, Matthew W. Martinez

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Elevation in cardiac troponins is common with sepsis despite unclear impact. Hypothesis: We investigated whether demand ischemia(DI) resulted in variable outcomes compared to acute myocardial infarction(AMI) and those with neither DI nor AMI in sepsis. Methods: We analyzed data from the 2011-2014 National Inpatient Sample among patients admitted for sepsis. We compared outcomes among patients with DI i) versus AMI and ii) versus neither DI nor AMI, respectively using propensity matching. Primary study end-point was in-hospital mortality. Results: We studied 666,154 patients, with mean age 63.7 years and 50.8% female participants. Overall, 94.7% of the included patients had neither DI nor AMI, 4.4% had AMI and 0.83% had DI. Between 2011 and 2014, we observed an increasing trend for DI but decreasing trend for AMI in sepsis. Patients with DI experienced higher rates of atrial and ventricular arrhythmias, had longer length of stay and higher cost of stay compared to patients with neither demand ischemia nor AMI. Despite higher hospital mortality at baseline with DI, post-propensity matching revealed no difference in hospital mortality between patients with DI and those with neither (26.9% vs. 27.0%, adjusted odds ratio 0.99, 95% confidence intervals 0.92-1.07;p=0.87). Patients with DI experienced lower hospital mortality compared to those with AMI pre (28.5% vs. 48.3%;p<0.001) and post-propensity matching (41.1% vs. 29.1%, aOR 0.58, 95% CI 0.54-0.63;p<0.001). Conclusion: Among patients with sepsis, those with DI had similar adjusted in-hospital mortality compared to those with neither DI nor AMI. Patients with AMI had the highest in-hospital mortality among all groups.

Original languageEnglish (US)
Pages (from-to)936-944
Number of pages9
JournalClinical Cardiology
Volume41
Issue number7
DOIs
StatePublished - Jul 1 2018

Fingerprint

Sepsis
Ischemia
Myocardial Infarction
Mortality
Hospital Mortality
Troponin
Cardiac Arrhythmias
Inpatients
Length of Stay
Odds Ratio
Confidence Intervals
Costs and Cost Analysis

Keywords

  • acute myocardial infarction
  • arrhythmias
  • demand ischemia
  • mortality
  • sepsis
  • type II myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mortality in sepsis : Comparison of outcomes between patients with demand ischemia, acute myocardial infarction, and neither demand ischemia nor acute myocardial infarction. / Shah, Mahek; Patnaik, Soumya; Maludum, Obiora; Patel, Brijesh; Tripathi, Byomesh; Agarwal, Manyoo; Garg, Lohit; Agrawal, Sahil; Jorde, Ulrich P.; Martinez, Matthew W.

In: Clinical Cardiology, Vol. 41, No. 7, 01.07.2018, p. 936-944.

Research output: Contribution to journalArticle

Shah, Mahek ; Patnaik, Soumya ; Maludum, Obiora ; Patel, Brijesh ; Tripathi, Byomesh ; Agarwal, Manyoo ; Garg, Lohit ; Agrawal, Sahil ; Jorde, Ulrich P. ; Martinez, Matthew W. / Mortality in sepsis : Comparison of outcomes between patients with demand ischemia, acute myocardial infarction, and neither demand ischemia nor acute myocardial infarction. In: Clinical Cardiology. 2018 ; Vol. 41, No. 7. pp. 936-944.
@article{1b30b88aec9a4147910c386a5d4b5e8d,
title = "Mortality in sepsis: Comparison of outcomes between patients with demand ischemia, acute myocardial infarction, and neither demand ischemia nor acute myocardial infarction",
abstract = "Introduction: Elevation in cardiac troponins is common with sepsis despite unclear impact. Hypothesis: We investigated whether demand ischemia(DI) resulted in variable outcomes compared to acute myocardial infarction(AMI) and those with neither DI nor AMI in sepsis. Methods: We analyzed data from the 2011-2014 National Inpatient Sample among patients admitted for sepsis. We compared outcomes among patients with DI i) versus AMI and ii) versus neither DI nor AMI, respectively using propensity matching. Primary study end-point was in-hospital mortality. Results: We studied 666,154 patients, with mean age 63.7 years and 50.8{\%} female participants. Overall, 94.7{\%} of the included patients had neither DI nor AMI, 4.4{\%} had AMI and 0.83{\%} had DI. Between 2011 and 2014, we observed an increasing trend for DI but decreasing trend for AMI in sepsis. Patients with DI experienced higher rates of atrial and ventricular arrhythmias, had longer length of stay and higher cost of stay compared to patients with neither demand ischemia nor AMI. Despite higher hospital mortality at baseline with DI, post-propensity matching revealed no difference in hospital mortality between patients with DI and those with neither (26.9{\%} vs. 27.0{\%}, adjusted odds ratio 0.99, 95{\%} confidence intervals 0.92-1.07;p=0.87). Patients with DI experienced lower hospital mortality compared to those with AMI pre (28.5{\%} vs. 48.3{\%};p<0.001) and post-propensity matching (41.1{\%} vs. 29.1{\%}, aOR 0.58, 95{\%} CI 0.54-0.63;p<0.001). Conclusion: Among patients with sepsis, those with DI had similar adjusted in-hospital mortality compared to those with neither DI nor AMI. Patients with AMI had the highest in-hospital mortality among all groups.",
keywords = "acute myocardial infarction, arrhythmias, demand ischemia, mortality, sepsis, type II myocardial infarction",
author = "Mahek Shah and Soumya Patnaik and Obiora Maludum and Brijesh Patel and Byomesh Tripathi and Manyoo Agarwal and Lohit Garg and Sahil Agrawal and Jorde, {Ulrich P.} and Martinez, {Matthew W.}",
year = "2018",
month = "7",
day = "1",
doi = "10.1002/clc.22978",
language = "English (US)",
volume = "41",
pages = "936--944",
journal = "Clinical Cardiology",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",
number = "7",

}

TY - JOUR

T1 - Mortality in sepsis

T2 - Comparison of outcomes between patients with demand ischemia, acute myocardial infarction, and neither demand ischemia nor acute myocardial infarction

AU - Shah, Mahek

AU - Patnaik, Soumya

AU - Maludum, Obiora

AU - Patel, Brijesh

AU - Tripathi, Byomesh

AU - Agarwal, Manyoo

AU - Garg, Lohit

AU - Agrawal, Sahil

AU - Jorde, Ulrich P.

AU - Martinez, Matthew W.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Introduction: Elevation in cardiac troponins is common with sepsis despite unclear impact. Hypothesis: We investigated whether demand ischemia(DI) resulted in variable outcomes compared to acute myocardial infarction(AMI) and those with neither DI nor AMI in sepsis. Methods: We analyzed data from the 2011-2014 National Inpatient Sample among patients admitted for sepsis. We compared outcomes among patients with DI i) versus AMI and ii) versus neither DI nor AMI, respectively using propensity matching. Primary study end-point was in-hospital mortality. Results: We studied 666,154 patients, with mean age 63.7 years and 50.8% female participants. Overall, 94.7% of the included patients had neither DI nor AMI, 4.4% had AMI and 0.83% had DI. Between 2011 and 2014, we observed an increasing trend for DI but decreasing trend for AMI in sepsis. Patients with DI experienced higher rates of atrial and ventricular arrhythmias, had longer length of stay and higher cost of stay compared to patients with neither demand ischemia nor AMI. Despite higher hospital mortality at baseline with DI, post-propensity matching revealed no difference in hospital mortality between patients with DI and those with neither (26.9% vs. 27.0%, adjusted odds ratio 0.99, 95% confidence intervals 0.92-1.07;p=0.87). Patients with DI experienced lower hospital mortality compared to those with AMI pre (28.5% vs. 48.3%;p<0.001) and post-propensity matching (41.1% vs. 29.1%, aOR 0.58, 95% CI 0.54-0.63;p<0.001). Conclusion: Among patients with sepsis, those with DI had similar adjusted in-hospital mortality compared to those with neither DI nor AMI. Patients with AMI had the highest in-hospital mortality among all groups.

AB - Introduction: Elevation in cardiac troponins is common with sepsis despite unclear impact. Hypothesis: We investigated whether demand ischemia(DI) resulted in variable outcomes compared to acute myocardial infarction(AMI) and those with neither DI nor AMI in sepsis. Methods: We analyzed data from the 2011-2014 National Inpatient Sample among patients admitted for sepsis. We compared outcomes among patients with DI i) versus AMI and ii) versus neither DI nor AMI, respectively using propensity matching. Primary study end-point was in-hospital mortality. Results: We studied 666,154 patients, with mean age 63.7 years and 50.8% female participants. Overall, 94.7% of the included patients had neither DI nor AMI, 4.4% had AMI and 0.83% had DI. Between 2011 and 2014, we observed an increasing trend for DI but decreasing trend for AMI in sepsis. Patients with DI experienced higher rates of atrial and ventricular arrhythmias, had longer length of stay and higher cost of stay compared to patients with neither demand ischemia nor AMI. Despite higher hospital mortality at baseline with DI, post-propensity matching revealed no difference in hospital mortality between patients with DI and those with neither (26.9% vs. 27.0%, adjusted odds ratio 0.99, 95% confidence intervals 0.92-1.07;p=0.87). Patients with DI experienced lower hospital mortality compared to those with AMI pre (28.5% vs. 48.3%;p<0.001) and post-propensity matching (41.1% vs. 29.1%, aOR 0.58, 95% CI 0.54-0.63;p<0.001). Conclusion: Among patients with sepsis, those with DI had similar adjusted in-hospital mortality compared to those with neither DI nor AMI. Patients with AMI had the highest in-hospital mortality among all groups.

KW - acute myocardial infarction

KW - arrhythmias

KW - demand ischemia

KW - mortality

KW - sepsis

KW - type II myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=85050552402&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050552402&partnerID=8YFLogxK

U2 - 10.1002/clc.22978

DO - 10.1002/clc.22978

M3 - Article

C2 - 29774564

AN - SCOPUS:85050552402

VL - 41

SP - 936

EP - 944

JO - Clinical Cardiology

JF - Clinical Cardiology

SN - 0160-9289

IS - 7

ER -