Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals

Rhee C, Jones TM, Hamad Y, et al. JAMA Netw Open. 2019 Feb 1;2(2):e187571. [CrossRef] [PubMed]

Sepsis affects nearly 270,000 Americans each year and has a mortality risk of 30% to 60%. Nearly one in three patients who die in the hospital have sepsis, according to the Centers for Disease Control and Prevention and has been targeted as a preventable hospital-acquired infection by the Centers for Medicare and Medicaid Services. However, the extent to which sepsis is preventable, is unknown.

The authors conduced a retrospective cohort study of 568 randomly selected adults admitted to 6 US academic and community hospitals who died in the hospital or were discharged to hospice and not readmitted. The preventability of each sepsis-associated death was rated on a 6-point Likert scale.

Sepsis was present in 300 of the 568 subjects and was the immediate cause of death in 198 cases. The next most common immediate causes of death were progressive cancer (92) and heart failure (39). Suboptimal care, most commonly delays in antibiotics, was identified in 68 of 300 sepsis-associated deaths. However, only 11 sepsis-associated deaths (3.7%) were judged definitely or moderately likely preventable; another 25 sepsis-associated deaths (8.3%) were considered possibly preventable.

The authors conclude that in this cohort from 6 US hospitals, sepsis was the most common immediate cause of death. However, most underlying causes of death were related to severe chronic comorbidities and most sepsis-associated deaths were unlikely to be preventable through better hospital-based care.