Mortality in sepsis: Comparison of outcomes between patients with demand ischemia, acute myocardial infarction, and neither demand ischemia nor acute myocardial infarction

Abstract

Introduction: Elevation in cardiac troponins is common with sepsis despite unclear impact.

Hypothesis: We investigated whether demand ischemia(DI) resulted in variable outcomes compared to acute myocardial infarction(AMI) and those with neither DI nor AMI in sepsis.

Methods: We analyzed data from the 2011-2014 National Inpatient Sample among patients admitted for sepsis. We compared outcomes among patients with DI i) versus AMI and ii) versus neither DI nor AMI, respectively using propensity matching. Primary study end-point was in-hospital mortality.

Results: We studied 666,154 patients, with mean age 63.7 years and 50.8% female participants. Overall, 94.7% of the included patients had neither DI nor AMI, 4.4% had AMI and 0.83% had DI. Between 2011 and 2014, we observed an increasing trend for DI but decreasing trend for AMI in sepsis. Patients with DI experienced higher rates of atrial and ventricular arrhythmias, had longer length of stay and higher cost of stay compared to patients with neither demand ischemia nor AMI. Despite higher hospital mortality at baseline with DI, post-propensity matching revealed no difference in hospital mortality between patients with DI and those with neither (26.9% vs. 27.0%, adjusted odds ratio 0.99, 95% confidence intervals 0.92-1.07;p=0.87). Patients with DI experienced lower hospital mortality compared to those with AMI pre (28.5% vs. 48.3%;p<0.001) and post-propensity matching (41.1% vs. 29.1%, aOR 0.58, 95% CI 0.54-0.63;p<0.001).

Conclusion: Among patients with sepsis, those with DI had similar adjusted in-hospital mortality compared to those with neither DI nor AMI. Patients with AMI had the highest in-hospital mortality among all groups.

Keywords: acute myocardial infarction; arrhythmias; demand ischemia; mortality; sepsis; type II myocardial infarction.