Risk Factors for Myocardial Infarction and Stroke Among Sepsis Survivors: A Competing Risks Analysis

Yueh Che Hsieh, Po Yang Tsou, Yu Hsun Wang, Christin Chih Ting Chao, Wan Chien Lee, Meng tse Gabriel Lee, Jiunn Yih Wu, Shy Shin Chang, Po Yen Chen, Chien Chang Lee

Research output: Contribution to journalReview article

Abstract

Objectives: Predictors for post-sepsis myocardial infarction (MI) and stroke are yet to be identified due to the competing risk of death. Methods: This study included all hospitalized patients with sepsis from National Health Insurance Research Database of Taiwan between 2000 and 2011. The primary outcome was the first occurrence of MI and stroke requiring hospitalization within 180 days following hospital discharge from the index sepsis episode. The association between predictors and post-sepsis MI and stroke were analyzed using cumulative incidence competing risk model that controlled for the competing risk of death. Results: Among 42 316 patients with sepsis, 1012 (2.4%) patients developed MI and stroke within 180 days of hospital discharge. The leading 5 predictors for post-sepsis MI and stroke are prior cerebrovascular diseases (hazard ratio [HR]: 2.02, 95% confidence interval [CI]: 1.74-2.32), intra-abdominal infection (HR: 1.94, 95% CI: 1.71-2.20), previous MI (HR: 1.81, 95% CI: 1.53-2.15), lower respiratory tract infection (HR: 1.62, 95% CI: 1.43-1.85), and septic encephalopathy (HR: 1.61, 95% CI: 1.26-2.06). Conclusions: Baseline comorbidities and sources of infection were associated with an increased risk of post-sepsis MI and stroke. The identified risk factors may help physicians select a group of patients with sepsis who may benefit from preventive measures, antiplatelet treatment, and other preventive measures for post-sepsis MI and stroke.

Original languageEnglish
Pages (from-to)34-41
Number of pages8
JournalJournal of Intensive Care Medicine
Volume35
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

Keywords

  • cardiovascular complications
  • sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Hsieh, Y. C., Tsou, P. Y., Wang, Y. H., Chao, C. C. T., Lee, W. C., Lee, M. T. G., Wu, J. Y., Chang, S. S., Chen, P. Y., & Lee, C. C. (2020). Risk Factors for Myocardial Infarction and Stroke Among Sepsis Survivors: A Competing Risks Analysis. Journal of Intensive Care Medicine, 35(1), 34-41. https://doi.org/10.1177/0885066619844936