Prevalence of Peripheral Artery Disease Among Adults with SepsisIyer, Stuthi S. (2023) Prevalence of Peripheral Artery Disease Among Adults with Sepsis. Master Essay, University of Pittsburgh.
AbstractIntroduction: Sepsis is common, deadly, and exacerbated by comorbid conditions. Peripheral artery disease (PAD) is one such condition, affecting >230 million people worldwide. PAD can lead to de novo ischemic wounds and retarded wound healing, that increase the risk of sepsis. We aimed to establish the prevalence of PAD among sepsis hospitalizations and hypothesized PAD would be associated with higher risk of in-hospital mortality and amputation among sepsis hospitalizations. Methods: We conducted a retrospective, secondary analysis of discharge data from the 2018 National Inpatient Sample (NIS). NIS data with survey-weights generates national sepsis admission population prevalence estimates. We included hospitalizations with a primary diagnosis of sepsis and excluded non-adult patients (<18 years), and those with missing outcome (i.e., in-hospital mortality) and demographic (i.e., age, sex, race/ethnicity) data. Associations between PAD and in-hospital mortality or amputation among sepsis hospitalizations were evaluated using log-binomial regression, adjusting for demographics (age, race/ethnicity, sex, income) and a modified Elixhauser Comorbidity Index, which excluded peripheral vascular diseases. Results: Of 35,527,481 hospitalizations (age mean ± standard error (SE): 49.9±0.2, 44% male, 65% White), 1,955,275 (5.5%, 95% confidence interval (CI): 5.4-5.6%) had a primary diagnosis of sepsis (age: 68.8±0.1, 50% male, 70% White); of which, 9,105 (0.5%, 95% CI 0.44-0.49%) had a secondary diagnosis of PAD (age: 71.1±0.3, 62% male, 67% White). Among sepsis hospitalizations, 10% had in-hospital mortality and 0.3% a major or transmetatarsal amputation. PAD was associated with a 14% higher risk of in-hospital mortality (95% CI: 1.01-1.29) and 24 times the risk of major or transmetatarsal amputation (95% CI: 19.7-29.0). Conclusions: Among sepsis hospitalizations, comorbid PAD was infrequent. When present, PAD was associated with significantly higher risk of in-hospital mortality and major or transmetatarsal amputation, even after adjusting for demographics and the modified Elixhauser Comorbidity Index. Understanding the risks of in-hospital mortality and amputation among sepsis hospitalizations may inform high-risk subgroups that may need additional and more intensive care and interventions to prevent limb and life loss. Share
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