Risk of out-of-hospital cardiac arrest among sepsis survivors in Taiwan: analysis of a nationwide population-based cohort

Wan-Ting Hsu; Charles Fox Sherrod; Babak Tehrani; Alexa Papaila; Lorenzo Porta; Tzu-Chun Hsu; Wang-Huei Sheng; Chien-Chang Lee

doi:10.1136/bmjopen-2021-051502

Risk of out-of-hospital cardiac arrest among sepsis survivors in Taiwan: analysis of a nationwide population-based cohort

BMJ Open. 2021 Sep 14;11(9):e051502. doi: 10.1136/bmjopen-2021-051502.

Authors

Wan-Ting Hsu¹, Charles Fox Sherrod², Babak Tehrani², Alexa Papaila², Lorenzo Porta³, Tzu-Chun Hsu⁴, Wang-Huei Sheng⁵, Chien-Chang Lee^{6

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Affiliations

¹ Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.
² Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
³ Department of Emergency Medicine, Università degli Studi di Milano-Bicocca, Milano, Italy.
⁴ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁶ Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan cclee100@gmail.com.
⁷ The Centre for Intelligent Healthcare, National Taiwan University Hospital, Taipei, Taiwan.
⁸ Byers Center for Biodesign, School of Medicine, Stanford University, Palo Alto, CA, USA.

Abstract

Objectives: There is minimal literature examining the association of sepsis with out-of-hospital cardiac arrest (OHCA). Using a large national database, we aimed to quantify the risk of OHCA among sepsis patients after hospital discharge.

Design: Population-based cohort study.

Setting: Nationwide sepsis cohort retrieved from the National Health Insurance Research Database of Taiwan between 2000 and 2013.

Participants: We included 17 304 patients with sepsis. After hospital discharge, 144 patients developed OHCA within 30 days and 640 between days 31 and 365.

Primary and secondary outcome measures: The main outcomes were OHCA events following hospital discharge for sepsis. To evaluate the independent association between sepsis and OHCA after a sepsis hospitalisation, we constructed two non-sepsis comparison cohorts using risk set sampling and propensity score matching techniques (non-infection cohort, non-sepsis infection cohort). We plotted the daily number and daily risk of OHCA within 1 year of hospital discharge between sepsis and matched non-sepsis cohorts. We used Cox regression to evaluate the risk of early and late OHCA, comparing sepsis to non-sepsis patients.

Results: Compared with non-infected patients, sepsis patients had a higher rate of early (HR 1.66, 95% CI: 1.27 to 2.16) and late (HR 1.19, 95% CI: 1.06 to 1.33) OHCA events. This association was independent of age, sex or cardiovascular history. Compared with non-sepsis patients with infections, sepsis patients had a higher rate of both early (HR 1.28, 95% CI: 1.00 to 1.63) and late (HR 1.13, 95% CI: 1.01 to 1.27) OHCA events, especially among patients with cardiovascular disease (OR 1.35, 95% CI: 1.01 to 1.81).

Conclusions: Sepsis patients had increased risk of OHCA compared with matched non-sepsis controls, which lasted up to 1 year after hospital discharge.

Keywords: adult intensive & critical care; cardiology; epidemiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiopulmonary Resuscitation*
Cohort Studies
Humans
Out-of-Hospital Cardiac Arrest* / epidemiology
Sepsis* / epidemiology
Survivors
Taiwan / epidemiology