@article {9245, title = {Late mortality after acute hypoxic respiratory failure.}, journal = {Thorax}, year = {2017}, abstract = {

BACKGROUND: Acute hypoxic respiratory failure (AHRF) is associated with significant acute mortality. It is unclear whether later mortality is predominantly driven by pre-existing comorbid disease, the acute inciting event or is the result of AHRF itself.

METHODS: Observational cohort study of elderly US Health and Retirement Study (HRS) participants in fee-for-service Medicare (1998-2012). Patients hospitalised with AHRF were matched 1:1 to otherwise similar adults who were not currently hospitalised and separately to patients hospitalised with acute inciting events (pneumonia, non-pulmonary infection, aspiration, trauma, pancreatitis) that may result in AHRF, here termed at-risk hospitalisations. The primary outcome was late mortality-death in the 31 days to 2 years following hospital admission.

RESULTS: Among 15 075 HRS participants, we identified 1268 AHRF and 13 117 at-risk hospitalisations. AHRF hospitalisations were matched to 1157 non-hospitalised adults and 1017 at-risk hospitalisations. Among patients who survived at least 30 days, AHRF was associated with a 24.4\% (95\%CI 19.9\% to 28.9\%, p<0.001) absolute increase in late mortality relative to adults not currently hospitalised and a 6.7\% (95\%CI 1.7\% to 11.7\%, p=0.01) increase relative to adults hospitalised with acute inciting event(s) alone. At-risk hospitalisation explained 71.2\% of the increased odds of late mortality, whereas the development of AHRF itself explained 28.8\%. Risk for death was equivalent to at-risk hospitalisation beyond 90 days, but remained elevated for more than 1 year compared with non-hospitalised controls.

CONCLUSIONS: In this national sample of older Americans, approximately one in four survivors with AHRF had a late death not explained by pre-AHRF health status. More than 70\% of this increased risk was associated with hospitalisation for acute inciting events, while 30\% was associated with hypoxemic respiratory failure.

}, keywords = {Health Shocks, Mortality, Respiratory Disease}, issn = {1468-3296}, doi = {10.1136/thoraxjnl-2017-210109}, author = {Hallie C Prescott and Sjoding, Michael W and Kenneth M. Langa and Theodore J Iwashyna and Daniel F McAuley} } @article {8547, title = {Late mortality after sepsis: propensity matched cohort study.}, journal = {BMJ}, volume = {353}, year = {2016}, month = {2016 May 17}, pages = {i2375}, abstract = {

OBJECTIVES: ~To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

DEIGN: ~Observational cohort study.

SETTING: ~US Health and Retirement Study.

PARTICIPANTS: ~960 patients aged >=65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

MAIN OUTCOME MEASURES: ~Late (31 days to two years) mortality and odds of death at various intervals.

RESULTS: ~Sepsis was associated with a 22.1\% (95\% confidence interval 17.5\% to 26.7\%) absolute increase in late mortality relative to adults not in hospital, a 10.4\% (5.4\% to 15.4\%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2\% (10.2\% to 22.2\%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

CONCLUSIONS: ~More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

}, keywords = {Aged, Aged, 80 and over, Case-Control Studies, Cause of Death, Female, Hospital Mortality, Hospitalization, Humans, Longitudinal Studies, Male, Medicare, Propensity Score, Prospective Studies, Sepsis, Time Factors, United States}, issn = {1756-1833}, doi = {10.1136/bmj.i2375}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27189000}, author = {Hallie C Prescott and Osterholzer, John J and Kenneth M. Langa and Angus, Derek C and Theodore J Iwashyna} } @article {7528, title = {Long-term cognitive impairment and functional disability among survivors of severe sepsis.}, journal = {JAMA}, volume = {304}, year = {2010}, month = {2010 Oct 27}, pages = {1787-94}, publisher = {304}, abstract = {

CONTEXT: Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients{\textquoteright} long-term cognitive and functional limitations after sepsis is unknown.

OBJECTIVE: To determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis, controlling for their presepsis functioning.

DESIGN, SETTING, AND PATIENTS: A prospective cohort involving 1194 patients with 1520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of US residents (1998-2006). A total of 9223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey and are included in the analysis.

MAIN OUTCOME MEASURES: Personal interviews were conducted with respondents or proxies using validated surveys to assess the presence of cognitive impairment and to determine the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance.

RESULTS: Survivors{\textquoteright} mean age at hospitalization was 76.9 years. The prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio (OR) of 3.34 (95\% confidence interval [CI], 1.53-7.25) in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis: in those with no limits before sepsis, a mean 1.57 new limitations (95\% CI, 0.99-2.15); and for those with mild to moderate limitations before sepsis, a mean of 1.50 new limitations (95\% CI, 0.87-2.12). In contrast, nonsepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment (OR, 1.15; 95\% CI, 0.80-1.67; P for difference vs sepsis = .01) and with the development of fewer new limitations (mean among those with no limits before hospitalization, 0.48; 95\% CI, 0.39-0.57; P for difference vs sepsis <.001 and mean among those with mild to moderate limits, 0.43; 95\% CI, 0.23-0.63; P for difference = .001). The declines in cognitive and physical function persisted for at least 8 years.

CONCLUSIONS: Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients{\textquoteright} ability to live independently.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Case-Control Studies, Cognition Disorders, Disabled Persons, Female, Health Status, Hospitalization, Humans, Male, Prospective Studies, Sepsis, Severity of Illness Index, Survivors, United States}, issn = {1538-3598}, doi = {10.1001/jama.2010.1553}, url = {http://jama.ama-assn.org/content/304/16/1787.abstract}, author = {Theodore J Iwashyna and E Wesley Ely and Dylan M Smith and Kenneth M. Langa} }