Epidemiology of Community-Acquired Versus Hospital-Acquired Sepsis in Acute Hospitals in Ireland, 2016-2022.

Abstract

Importance: Sepsis is a leading cause of morbidity and mortality. Understanding sepsis epidemiology is crucial to enable clinicians to identify patients at highest risk of developing and dying from sepsis.

Objectives: While community-acquired (CA) sepsis has been identified as more common than hospital-acquired (HA) sepsis, HA sepsis has led to increased morbidity and mortality. Few studies, however, have analyzed CA and HA sepsis by site of infection or by patient comorbidities. The aim of this analysis was to describe the epidemiology of patients with CA and HA sepsis diagnosed in Ireland.

Design, setting, and participants: This was a retrospective cohort study. The setting was all Irish acute public hospitals from 2016 to 2022. Data were extracted from the Hospital In-Patient Enquiry (HIPE) system recording all discharges from acute public hospitals, if a sepsis-related diagnostic code was included.

Main outcomes and measures: Univariate and multivariate analysis was conducted to compare CA and HA sepsis events and their association with sepsis-associated mortality.

Results: The number of CA vs. HA sepsis events in the database was 86,011 (85.2%) vs. 14,930 (14.8%). HA sepsis patients were 1.5 times more likely to die in hospital compared with CA. Of diagnoses analyzed, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the strongest risk factor predictive of mortality (odds ratio [OR] = 2.4) followed by cardiac disease (OR, 1.9) and influenza or pneumonia (OR, 1.9). Sepsis patients with a lower socioeconomic status had a 20% higher likelihood of death.

Conclusions and relevance: This analysis highlighted a significant increased risk of sepsis-associated mortality for patients diagnosed with sepsis as a result of a HA infection and key infection types and comorbidities including SARS-CoV-2, influenza or pneumonia, cancer, and cardiac disease.