Sepsis patients face higher death risk at hospitals treating small numbers of them

Immunosuppressed patients with sepsis may face a greater risk of mortality if they are cared for in a hospital that treats a small number of these patients, according to research published in the Annals of the American Thoracic Society.

The researchers looked at the medical records of 350,183 patients with sepsis at 60 U.S. hospitals. One of every five of these patients was classified as being immunocompromised, including those who are HIV-positive, have an intrinsic immune disorder or were diagnosed with a blood cancer.

"While there is a lot of focus on improving sepsis outcomes through early interventions, some patients have poor outcomes from sepsis because their chronic medical conditions may worsen after the initial infectious insult," said study author Jared Greenberg, MD.

"We hypothesized that septic patients who are immunocompromised may have improved outcomes if they are managed at hospitals that have the most experience managing immunocompromising conditions."

Five study insights:

1. Study findings revealed 15 percent of immunosuppressed patients with sepsis died during hospitalization as opposed to 12 percent of non-immunosuppressed patients with sepsis at all hospitals.

2. At hospitals that treated fewer than 225 immunosuppressed patients with sepsis annually, these patients were 38 percent more likely to die while hospitalized, while these patients were 21 percent more likely to die at hospitals that saw 225 or more of these patients each year.

3. At hospitals that treated above 225 of these patients annually, caring for greater numbers of immunosuppressed patients with sepsis did not decrease mortality.

4. The study also found that immunosuppressed patients with sepsis were more likely (60 percent) than non-immunosuppressed patients (50 percent) to return to their homes after discharge instead of a different health facility.

5. The study is important for hospital administrators and clinicians focused on improving quality of sepsis care because "patients with a medical condition that is relatively uncommon at a hospital may have worse outcomes from sepsis than patients with the same conditions who are managed at hospitals where the condition is more common," Dr. Greenberg said.

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