Multimorbidity patterns and outcomes among adults (non-maternity) with community-onset sepsis in Ireland: a retrospective national analysis of acute hospital data, 2020-2025.

IF 2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Irish Journal of Medical Science Pub Date : 2026-10-10 DOI:10.1007/s11845-026-04662-y

Nandakumar Ravichandran, Diarmuid Quinlan, Patricia Fitzpatrick, Ellen Hayes, Mick Molloy, Etimbuk Umana, Tomas Breslin, Aoife Cotter, Walter Cullen

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引用次数: 0

Abstract

Background: Community-onset sepsis accounts for most sepsis cases and frequently occurs in individuals with underlying comorbidity. While national analyses in Ireland have described its epidemiology, impact of multimorbidity and how comorbidities co-exist to form patterns remain poorly characterised.

Objectives: To identify multimorbidity patterns among adult (non-maternity) episodes with community-onset sepsis and examine their association with critical care admission and in-hospital mortality.

Methods: We conducted a secondary analysis of Hospital In-Patient Enquiry data from all acute public hospitals in Ireland from January 2020 to December 2025. Community-onset sepsis was defined using the present-on-admission flag. The sample comprised adult episodes aged ≥ 16 years excluding maternal admissions from conception to 6 weeks postpartum. K-means clustering identified patterns of co-occurring diseases. Multivariable logistic and negative binomial regression examined associations between patterns and outcomes.

Results: Of 80,628 sepsis admissions, 58,101 (72.0%) were community-onset. Of these, 53,812 (93.0%) were adult (non-maternity); of these, 35,316 (65.6%) had at least one Charlson comorbidity. Five data-derived multimorbidity patterns were identified: metabolic-multimorbid (31%), oncological-dominant (29%), renal-metabolic (15%), progressive metabolic (13%) and cardiopulmonary (12%). Outcomes varied across patterns, with differences in critical care admission and in-hospital mortality. Cardiopulmonary pattern had the highest odds of in-hospital mortality (adjusted-OR 2.01, 95% CI 1.86-2.17).

Conclusions: Charlson comorbidity was recorded in approximately two-thirds of adult community-onset sepsis episodes and formed data-derived patterns associated with differences in critical care admission and in-hospital mortality. Multimorbidity clustering may support future risk stratification research and targeted clinical vigilance for episodes at highest risk of adverse outcomes.

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爱尔兰社区发病脓毒症成人（非孕妇）的多发病模式和结局：2020-2025年急性医院数据的回顾性全国分析

背景：社区发生的脓毒症占大多数脓毒症病例，经常发生在有潜在合并症的个体。虽然爱尔兰的国家分析描述了其流行病学，但多病的影响以及合并症如何共存形成模式的特征仍然很差。目的：确定成人（非产妇）社区发病脓毒症发作的多发病模式，并研究其与重症监护住院和住院死亡率的关系。方法：我们对2020年1月至2025年12月爱尔兰所有急性公立医院的住院患者查询数据进行了二次分析。社区发病脓毒症的定义采用入院标志。样本包括年龄≥16岁的成人发作，不包括从怀孕到产后6周的产妇入院。k -均值聚类确定了共发疾病的模式。多变量逻辑回归和负二项回归检验了模式和结果之间的关联。结果：80,628例败血症入院患者中，58,101例（72.0%）为社区发病。其中53,812人（93.0%）为成人（非产妇）；其中35316例（65.6%）至少有一种查理森合并症。确定了五种数据衍生的多发病模式：代谢-多发病（31%），肿瘤-显性（29%），肾脏-代谢（15%），进行性代谢（13%）和心肺（12%）。不同模式的结果不同，在重症监护住院率和住院死亡率方面存在差异。心肺模式的住院死亡率最高（调整比值比2.01,95% CI 1.86-2.17）。结论：大约三分之二的成人社区性败血症发作记录了Charlson合并症，并形成了与重症监护住院和住院死亡率差异相关的数据衍生模式。多病聚类可能支持未来的风险分层研究和对不良后果风险最高的发作有针对性的临床警惕。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Irish Journal of Medical Science 医学-医学：内科

CiteScore

3.70

自引率

4.80%

发文量

357

审稿时长

4-8 weeks

期刊介绍： The Irish Journal of Medical Science is the official organ of the Royal Academy of Medicine in Ireland. Established in 1832, this quarterly journal is a contribution to medical science and an ideal forum for the younger medical/scientific professional to enter world literature and an ideal launching platform now, as in the past, for many a young research worker. The primary role of both the Academy and IJMS is that of providing a forum for the exchange of scientific information and to promote academic discussion, so essential to scientific progress.