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Case Fatality and Adverse Outcomes Are Reduced in Pregnant Women With Severe Sepsis or Septic Shock Compared With Age-Matched Comorbid-Matched Nonpregnant Women.
Crit Care Med. 2018 11; 46(11):1775-1782.CC

Abstract

OBJECTIVES

Case fatality in pregnancy-associated severe sepsis or septic shock appears reduced compared with nonpregnant women with severe sepsis or septic shock. It remains unclear if this difference is due to pregnancy or better baseline health status, among others. Our study compared adverse outcomes of pregnancy-associated severe sepsis or septic shock with nonpregnant women with severe sepsis or septic shock while controlling for age and chronic comorbidities.

DESIGN

Retrospective cohort study.

SETTING

Nationwide Inpatient Sample, a stratified sample of 20% acute care hospital admissions in the United States. Each entry includes patient and hospital characteristics as well as International Classification of Diseases, 9th revision, Clinical Modification, diagnoses and procedures.

SUBJECTS

Women of childbearing age (15-44 yr) with severe sepsis or septic shock-related hospitalizations during 1998-2012 identified using International Classification of Diseases, 9th revision, Clinical Modification, codes.

OUTCOMES

Case fatality, hospital length of stay, length of stay until death, number of organ failures, rates of mechanical ventilation, and hemodialysis were compared in women according to pregnancy status, controlling for age, and chronic comorbidities.

MEASUREMENTS AND MAIN RESULTS

We identified 5,968 pregnancy-associated severe sepsis or septic shock and 85,240 nonpregnant women with severe sepsis or septic shock hospitalizations. Crude case fatality of pregnancy-associated severe sepsis or septic shock (9.6%) was lower than nonpregnant women with severe sepsis or septic shock (16.8%). The rate ratio for case fatality adjusted for socioeconomic status and race was 0.57 (95% CI, 0.52-0.62) while sequential adjustments for age and chronic comorbidities did not eliminate the association (rate ratio, 0.62 [95% CI, 0.57-0.68]) and 0.63 [95% CI, 0.57-0.68], respectively). Pregnancy-associated severe sepsis or septic shock was associated with shorter hospital length of stay (-0.83 d [95% CI, -1.32 to -0.34 d]), longer length of stay until death (2.61 d; [95% CI, 1.28-3.94 d]), and fewer organ failures (rate ratio, 0.95 [95% CI, 0.94-0.97]).

CONCLUSIONS

Case fatality and adverse outcomes are reduced in women with pregnancy-associated severe sepsis or septic shock compared with nonpregnant women with severe sepsis or septic shock, and this is not explained by differences in age or chronic comorbidities alone. A less severe presentation of sepsis or protective effect of pregnancy may account for the difference observed with pregnancy-associated severe sepsis or septic shock.

Authors+Show Affiliations

Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30096100

Citation

Kidson, Kristen M., et al. "Case Fatality and Adverse Outcomes Are Reduced in Pregnant Women With Severe Sepsis or Septic Shock Compared With Age-Matched Comorbid-Matched Nonpregnant Women." Critical Care Medicine, vol. 46, no. 11, 2018, pp. 1775-1782.
Kidson KM, Henderson WR, Hutcheon JA. Case Fatality and Adverse Outcomes Are Reduced in Pregnant Women With Severe Sepsis or Septic Shock Compared With Age-Matched Comorbid-Matched Nonpregnant Women. Crit Care Med. 2018;46(11):1775-1782.
Kidson, K. M., Henderson, W. R., & Hutcheon, J. A. (2018). Case Fatality and Adverse Outcomes Are Reduced in Pregnant Women With Severe Sepsis or Septic Shock Compared With Age-Matched Comorbid-Matched Nonpregnant Women. Critical Care Medicine, 46(11), 1775-1782. https://doi.org/10.1097/CCM.0000000000003348
Kidson KM, Henderson WR, Hutcheon JA. Case Fatality and Adverse Outcomes Are Reduced in Pregnant Women With Severe Sepsis or Septic Shock Compared With Age-Matched Comorbid-Matched Nonpregnant Women. Crit Care Med. 2018;46(11):1775-1782. PubMed PMID: 30096100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case Fatality and Adverse Outcomes Are Reduced in Pregnant Women With Severe Sepsis or Septic Shock Compared With Age-Matched Comorbid-Matched Nonpregnant Women. AU - Kidson,Kristen M, AU - Henderson,William R, AU - Hutcheon,Jennifer A, PY - 2018/8/11/pubmed PY - 2019/9/24/medline PY - 2018/8/11/entrez SP - 1775 EP - 1782 JF - Critical care medicine JO - Crit Care Med VL - 46 IS - 11 N2 - OBJECTIVES: Case fatality in pregnancy-associated severe sepsis or septic shock appears reduced compared with nonpregnant women with severe sepsis or septic shock. It remains unclear if this difference is due to pregnancy or better baseline health status, among others. Our study compared adverse outcomes of pregnancy-associated severe sepsis or septic shock with nonpregnant women with severe sepsis or septic shock while controlling for age and chronic comorbidities. DESIGN: Retrospective cohort study. SETTING: Nationwide Inpatient Sample, a stratified sample of 20% acute care hospital admissions in the United States. Each entry includes patient and hospital characteristics as well as International Classification of Diseases, 9th revision, Clinical Modification, diagnoses and procedures. SUBJECTS: Women of childbearing age (15-44 yr) with severe sepsis or septic shock-related hospitalizations during 1998-2012 identified using International Classification of Diseases, 9th revision, Clinical Modification, codes. OUTCOMES: Case fatality, hospital length of stay, length of stay until death, number of organ failures, rates of mechanical ventilation, and hemodialysis were compared in women according to pregnancy status, controlling for age, and chronic comorbidities. MEASUREMENTS AND MAIN RESULTS: We identified 5,968 pregnancy-associated severe sepsis or septic shock and 85,240 nonpregnant women with severe sepsis or septic shock hospitalizations. Crude case fatality of pregnancy-associated severe sepsis or septic shock (9.6%) was lower than nonpregnant women with severe sepsis or septic shock (16.8%). The rate ratio for case fatality adjusted for socioeconomic status and race was 0.57 (95% CI, 0.52-0.62) while sequential adjustments for age and chronic comorbidities did not eliminate the association (rate ratio, 0.62 [95% CI, 0.57-0.68]) and 0.63 [95% CI, 0.57-0.68], respectively). Pregnancy-associated severe sepsis or septic shock was associated with shorter hospital length of stay (-0.83 d [95% CI, -1.32 to -0.34 d]), longer length of stay until death (2.61 d; [95% CI, 1.28-3.94 d]), and fewer organ failures (rate ratio, 0.95 [95% CI, 0.94-0.97]). CONCLUSIONS: Case fatality and adverse outcomes are reduced in women with pregnancy-associated severe sepsis or septic shock compared with nonpregnant women with severe sepsis or septic shock, and this is not explained by differences in age or chronic comorbidities alone. A less severe presentation of sepsis or protective effect of pregnancy may account for the difference observed with pregnancy-associated severe sepsis or septic shock. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/30096100/Case_Fatality_and_Adverse_Outcomes_Are_Reduced_in_Pregnant_Women_With_Severe_Sepsis_or_Septic_Shock_Compared_With_Age_Matched_Comorbid_Matched_Nonpregnant_Women_ L2 - https://dx.doi.org/10.1097/CCM.0000000000003348 DB - PRIME DP - Unbound Medicine ER -