Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization
OBJECTIVES:. Sepsis survivors face increased risk for cardiovascular complications; however, the contribution of intrasepsis events to cardiovascular risk profiles is unclear. SETTING:. Kaiser Permanente Northern California (KPNC) and Intermountain Healthcare (IH) integrated healthcare delivery syst...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-04-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000674 |
| _version_ | 1818553422673084416 |
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| author | Allan J. Walkey, MD, MSc Daniel B. Knox, MD Laura C. Myers, MD, MPH Khanh K. Thai, MS Jason R. Jacobs, PhD Patricia Kipnis, PhD Manisha Desai, PhD Alan S. Go, MD Yun Lu, MPH Samuel M. Brown, MD Adriana Martinez, BA Heather Clancy, MPH Ycar Devis, BS Vincent X. Liu, MD, MS |
| author_facet | Allan J. Walkey, MD, MSc Daniel B. Knox, MD Laura C. Myers, MD, MPH Khanh K. Thai, MS Jason R. Jacobs, PhD Patricia Kipnis, PhD Manisha Desai, PhD Alan S. Go, MD Yun Lu, MPH Samuel M. Brown, MD Adriana Martinez, BA Heather Clancy, MPH Ycar Devis, BS Vincent X. Liu, MD, MS |
| author_sort | Allan J. Walkey, MD, MSc |
| collection | DOAJ |
| description | OBJECTIVES:. Sepsis survivors face increased risk for cardiovascular complications; however, the contribution of intrasepsis events to cardiovascular risk profiles is unclear.
SETTING:. Kaiser Permanente Northern California (KPNC) and Intermountain Healthcare (IH) integrated healthcare delivery systems.
SUBJECTS:. Sepsis survivors (2011–2017 [KPNC] and 2018–2020 [IH]) greater than or equal to 40 years old without prior cardiovascular disease.
DESIGN:. Data across KPNC and IH were harmonized and grouped into presepsis (demographics, atherosclerotic cardiovascular disease scores, comorbidities) or intrasepsis factors (e.g., laboratory values, vital signs, organ support, infection source) with random split for training/internal validation datasets (75%/25%) within KPNC and IH. Models were bidirectionally, externally validated between healthcare systems.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. Changes to predictive accuracy (C-statistic) of cause-specific proportional hazards models predicting 1-year cardiovascular outcomes (atherosclerotic cardiovascular disease, heart failure, and atrial fibrillation events) were compared between models that did and did not contain intrasepsis factors. Among 39,590 KPNC and 16,388 IH sepsis survivors, 3,503 (8.8%) at Kaiser Permanente (KP) and 600 (3.7%) at IH experienced a cardiovascular event within 1-year after hospital discharge, including 996 (2.5%) at KP and 192 (1.2%) IH with an atherosclerotic event first, 564 (1.4%) at KP and 117 (0.7%) IH with a heart failure event, 2,310 (5.8%) at KP and 371 (2.3%) with an atrial fibrillation event. Death within 1 year after sepsis occurred for 7,948 (20%) KP and 2,085 (12.7%) IH patients. Combined models with presepsis and intrasepsis factors had better discrimination for cardiovascular events (KPNC C-statistic 0.783 [95% CI, 0.766–0.799]; IH 0.763 [0.726–0.801]) as compared with presepsis cardiovascular risk alone (KPNC: 0.666 [0.648–0.683], IH 0.660 [0.619–0.702]) during internal validation. External validation of models across healthcare systems showed similar performance (KPNC model within IH data C-statistic: 0.734 [0.725–0.744]; IH model within KPNC data: 0.787 [0.768–0.805]).
CONCLUSIONS:. Across two large healthcare systems, intrasepsis factors improved postsepsis cardiovascular risk prediction as compared with presepsis cardiovascular risk profiles. Further exploration of sepsis factors that contribute to postsepsis cardiovascular events is warranted for improved mechanistic and predictive models. |
| first_indexed | 2024-12-12T09:25:38Z |
| format | Article |
| id | doaj.art-313fc1c2e1ef4a56aca238dccadad9f6 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-12-12T09:25:38Z |
| publishDate | 2022-04-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-313fc1c2e1ef4a56aca238dccadad9f62022-12-22T00:29:03ZengWolters KluwerCritical Care Explorations2639-80282022-04-0144e067410.1097/CCE.0000000000000674202204000-00017Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis HospitalizationAllan J. Walkey, MD, MSc0Daniel B. Knox, MD1Laura C. Myers, MD, MPH2Khanh K. Thai, MS3Jason R. Jacobs, PhD4Patricia Kipnis, PhD5Manisha Desai, PhD6Alan S. Go, MD7Yun Lu, MPH8Samuel M. Brown, MD9Adriana Martinez, BA10Heather Clancy, MPH11Ycar Devis, BS12Vincent X. Liu, MD, MS131 The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA.2 Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT.4 The Permanente Medical Group, Oakland, CA.5 Division of Research, Kaiser Permanente Northern California, Oakland, CA.2 Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT.5 Division of Research, Kaiser Permanente Northern California, Oakland, CA.6 Quantitative Sciences Unit, Stanford University, Palo Alto, CA.4 The Permanente Medical Group, Oakland, CA.5 Division of Research, Kaiser Permanente Northern California, Oakland, CA.2 Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, UT.5 Division of Research, Kaiser Permanente Northern California, Oakland, CA.5 Division of Research, Kaiser Permanente Northern California, Oakland, CA.1 The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA.4 The Permanente Medical Group, Oakland, CA.OBJECTIVES:. Sepsis survivors face increased risk for cardiovascular complications; however, the contribution of intrasepsis events to cardiovascular risk profiles is unclear. SETTING:. Kaiser Permanente Northern California (KPNC) and Intermountain Healthcare (IH) integrated healthcare delivery systems. SUBJECTS:. Sepsis survivors (2011–2017 [KPNC] and 2018–2020 [IH]) greater than or equal to 40 years old without prior cardiovascular disease. DESIGN:. Data across KPNC and IH were harmonized and grouped into presepsis (demographics, atherosclerotic cardiovascular disease scores, comorbidities) or intrasepsis factors (e.g., laboratory values, vital signs, organ support, infection source) with random split for training/internal validation datasets (75%/25%) within KPNC and IH. Models were bidirectionally, externally validated between healthcare systems. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Changes to predictive accuracy (C-statistic) of cause-specific proportional hazards models predicting 1-year cardiovascular outcomes (atherosclerotic cardiovascular disease, heart failure, and atrial fibrillation events) were compared between models that did and did not contain intrasepsis factors. Among 39,590 KPNC and 16,388 IH sepsis survivors, 3,503 (8.8%) at Kaiser Permanente (KP) and 600 (3.7%) at IH experienced a cardiovascular event within 1-year after hospital discharge, including 996 (2.5%) at KP and 192 (1.2%) IH with an atherosclerotic event first, 564 (1.4%) at KP and 117 (0.7%) IH with a heart failure event, 2,310 (5.8%) at KP and 371 (2.3%) with an atrial fibrillation event. Death within 1 year after sepsis occurred for 7,948 (20%) KP and 2,085 (12.7%) IH patients. Combined models with presepsis and intrasepsis factors had better discrimination for cardiovascular events (KPNC C-statistic 0.783 [95% CI, 0.766–0.799]; IH 0.763 [0.726–0.801]) as compared with presepsis cardiovascular risk alone (KPNC: 0.666 [0.648–0.683], IH 0.660 [0.619–0.702]) during internal validation. External validation of models across healthcare systems showed similar performance (KPNC model within IH data C-statistic: 0.734 [0.725–0.744]; IH model within KPNC data: 0.787 [0.768–0.805]). CONCLUSIONS:. Across two large healthcare systems, intrasepsis factors improved postsepsis cardiovascular risk prediction as compared with presepsis cardiovascular risk profiles. Further exploration of sepsis factors that contribute to postsepsis cardiovascular events is warranted for improved mechanistic and predictive models.http://journals.lww.com/10.1097/CCE.0000000000000674 |
| spellingShingle | Allan J. Walkey, MD, MSc Daniel B. Knox, MD Laura C. Myers, MD, MPH Khanh K. Thai, MS Jason R. Jacobs, PhD Patricia Kipnis, PhD Manisha Desai, PhD Alan S. Go, MD Yun Lu, MPH Samuel M. Brown, MD Adriana Martinez, BA Heather Clancy, MPH Ycar Devis, BS Vincent X. Liu, MD, MS Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization Critical Care Explorations |
| title | Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization |
| title_full | Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization |
| title_fullStr | Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization |
| title_full_unstemmed | Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization |
| title_short | Prognostic Accuracy of Presepsis and Intrasepsis Characteristics for Prediction of Cardiovascular Events After a Sepsis Hospitalization |
| title_sort | prognostic accuracy of presepsis and intrasepsis characteristics for prediction of cardiovascular events after a sepsis hospitalization |
| url | http://journals.lww.com/10.1097/CCE.0000000000000674 |
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