Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? a matched case-control propensity-adjusted study

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Abstract

Background. Sepsis is a serious complication of solid organ transplant (SOT). Evidence on survival differences between SOT recipients and non-SOT patients with sepsis is lacking. Methods. This was a matched, case-control propensity-adjusted study. Conditional logistic regression was performed for risk factor analysis, and Cox proportional hazards regression for survival analysis. Results. Three hundred sixty-nine patients (123 cases; 246 controls) diagnosed with blood culture-proven sepsis were matched 1:2 by age, sex, and hospital location. The distribution of allografts was 36.6% kidney, 34.1% liver, 13% kidney-pancreas, 7.3% small bowel/liver, 5.7% heart/lung, and 3.3% multivisceral. The conditional logistic regression showed that the following factors were significantly more frequently associated with SOT compared to non-SOT: higher number of comorbidities (odds ratio [OR] = 8.2 [95% confidence interval {CI}, 1.48-45.44], P =.016); higher Sepsis-related Organ Failure Assessment score (OR = 1.2 [95% CI, 1.07-1.32], P =.001); presence of nosocomial infection (OR = 36.3 [95% CI, 9.71-135.96], P <.0001); appropriate initial antibiotics (OR = 0.04 [95% CI,.006-.23], P <.0001); and lower white blood cell count (OR = 0.93 [95% CI,.89-.97], P <.0001). Cox proportional hazards regression showed that after all adjustments for clinical presentation, severity of illness, and types of infection, SOT recipients with sepsis had a significantly lower risk of death at 28 days (hazard ratio [HR] = 0.22 [95% CI,.09-.54], P =.001) and at 90 days (HR = 0.43 [95% CI,.20-.89], P =.025). Conclusions. The 28-day and 90-day mortality were significantly decreased for transplant recipients compared with nontransplant patients. These findings suggest that the immunosuppression associated with transplantation may provide a survival advantage to transplant recipients with sepsis through modulation of the inflammatory response.

Original languageEnglish (US)
Pages (from-to)216-222
Number of pages7
JournalClinical Infectious Diseases
Volume60
Issue number2
DOIs
StatePublished - Jan 15 2015

Fingerprint

Sepsis
Confidence Intervals
Mortality
Transplants
Odds Ratio
Logistic Models
Organ Dysfunction Scores
Kidney
Survival
Liver
Survival Analysis
Cross Infection
Transplant Recipients
Leukocyte Count
Immunosuppression
Statistical Factor Analysis
Allografts
Comorbidity
Pancreas
Transplantation

Keywords

  • mortality
  • sepsis
  • transplantation

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{3b12311b1abe40deb539f9be3fd0f63b,
title = "Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? a matched case-control propensity-adjusted study",
abstract = "Background. Sepsis is a serious complication of solid organ transplant (SOT). Evidence on survival differences between SOT recipients and non-SOT patients with sepsis is lacking. Methods. This was a matched, case-control propensity-adjusted study. Conditional logistic regression was performed for risk factor analysis, and Cox proportional hazards regression for survival analysis. Results. Three hundred sixty-nine patients (123 cases; 246 controls) diagnosed with blood culture-proven sepsis were matched 1:2 by age, sex, and hospital location. The distribution of allografts was 36.6{\%} kidney, 34.1{\%} liver, 13{\%} kidney-pancreas, 7.3{\%} small bowel/liver, 5.7{\%} heart/lung, and 3.3{\%} multivisceral. The conditional logistic regression showed that the following factors were significantly more frequently associated with SOT compared to non-SOT: higher number of comorbidities (odds ratio [OR] = 8.2 [95{\%} confidence interval {CI}, 1.48-45.44], P =.016); higher Sepsis-related Organ Failure Assessment score (OR = 1.2 [95{\%} CI, 1.07-1.32], P =.001); presence of nosocomial infection (OR = 36.3 [95{\%} CI, 9.71-135.96], P <.0001); appropriate initial antibiotics (OR = 0.04 [95{\%} CI,.006-.23], P <.0001); and lower white blood cell count (OR = 0.93 [95{\%} CI,.89-.97], P <.0001). Cox proportional hazards regression showed that after all adjustments for clinical presentation, severity of illness, and types of infection, SOT recipients with sepsis had a significantly lower risk of death at 28 days (hazard ratio [HR] = 0.22 [95{\%} CI,.09-.54], P =.001) and at 90 days (HR = 0.43 [95{\%} CI,.20-.89], P =.025). Conclusions. The 28-day and 90-day mortality were significantly decreased for transplant recipients compared with nontransplant patients. These findings suggest that the immunosuppression associated with transplantation may provide a survival advantage to transplant recipients with sepsis through modulation of the inflammatory response.",
keywords = "mortality, sepsis, transplantation",
author = "Kalil, {Andre C} and Ather Syed and Rupp, {Mark Edmund} and Heather Chambers and Vargas, {Luciano M} and Maskin, {Alexander T} and Miles, {Clifford D} and Langnas, {Alan Norman} and Florescu, {Diana F}",
year = "2015",
month = "1",
day = "15",
doi = "10.1093/cid/ciu789",
language = "English (US)",
volume = "60",
pages = "216--222",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "2",

}

TY - JOUR

T1 - Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? a matched case-control propensity-adjusted study

AU - Kalil, Andre C

AU - Syed, Ather

AU - Rupp, Mark Edmund

AU - Chambers, Heather

AU - Vargas, Luciano M

AU - Maskin, Alexander T

AU - Miles, Clifford D

AU - Langnas, Alan Norman

AU - Florescu, Diana F

PY - 2015/1/15

Y1 - 2015/1/15

N2 - Background. Sepsis is a serious complication of solid organ transplant (SOT). Evidence on survival differences between SOT recipients and non-SOT patients with sepsis is lacking. Methods. This was a matched, case-control propensity-adjusted study. Conditional logistic regression was performed for risk factor analysis, and Cox proportional hazards regression for survival analysis. Results. Three hundred sixty-nine patients (123 cases; 246 controls) diagnosed with blood culture-proven sepsis were matched 1:2 by age, sex, and hospital location. The distribution of allografts was 36.6% kidney, 34.1% liver, 13% kidney-pancreas, 7.3% small bowel/liver, 5.7% heart/lung, and 3.3% multivisceral. The conditional logistic regression showed that the following factors were significantly more frequently associated with SOT compared to non-SOT: higher number of comorbidities (odds ratio [OR] = 8.2 [95% confidence interval {CI}, 1.48-45.44], P =.016); higher Sepsis-related Organ Failure Assessment score (OR = 1.2 [95% CI, 1.07-1.32], P =.001); presence of nosocomial infection (OR = 36.3 [95% CI, 9.71-135.96], P <.0001); appropriate initial antibiotics (OR = 0.04 [95% CI,.006-.23], P <.0001); and lower white blood cell count (OR = 0.93 [95% CI,.89-.97], P <.0001). Cox proportional hazards regression showed that after all adjustments for clinical presentation, severity of illness, and types of infection, SOT recipients with sepsis had a significantly lower risk of death at 28 days (hazard ratio [HR] = 0.22 [95% CI,.09-.54], P =.001) and at 90 days (HR = 0.43 [95% CI,.20-.89], P =.025). Conclusions. The 28-day and 90-day mortality were significantly decreased for transplant recipients compared with nontransplant patients. These findings suggest that the immunosuppression associated with transplantation may provide a survival advantage to transplant recipients with sepsis through modulation of the inflammatory response.

AB - Background. Sepsis is a serious complication of solid organ transplant (SOT). Evidence on survival differences between SOT recipients and non-SOT patients with sepsis is lacking. Methods. This was a matched, case-control propensity-adjusted study. Conditional logistic regression was performed for risk factor analysis, and Cox proportional hazards regression for survival analysis. Results. Three hundred sixty-nine patients (123 cases; 246 controls) diagnosed with blood culture-proven sepsis were matched 1:2 by age, sex, and hospital location. The distribution of allografts was 36.6% kidney, 34.1% liver, 13% kidney-pancreas, 7.3% small bowel/liver, 5.7% heart/lung, and 3.3% multivisceral. The conditional logistic regression showed that the following factors were significantly more frequently associated with SOT compared to non-SOT: higher number of comorbidities (odds ratio [OR] = 8.2 [95% confidence interval {CI}, 1.48-45.44], P =.016); higher Sepsis-related Organ Failure Assessment score (OR = 1.2 [95% CI, 1.07-1.32], P =.001); presence of nosocomial infection (OR = 36.3 [95% CI, 9.71-135.96], P <.0001); appropriate initial antibiotics (OR = 0.04 [95% CI,.006-.23], P <.0001); and lower white blood cell count (OR = 0.93 [95% CI,.89-.97], P <.0001). Cox proportional hazards regression showed that after all adjustments for clinical presentation, severity of illness, and types of infection, SOT recipients with sepsis had a significantly lower risk of death at 28 days (hazard ratio [HR] = 0.22 [95% CI,.09-.54], P =.001) and at 90 days (HR = 0.43 [95% CI,.20-.89], P =.025). Conclusions. The 28-day and 90-day mortality were significantly decreased for transplant recipients compared with nontransplant patients. These findings suggest that the immunosuppression associated with transplantation may provide a survival advantage to transplant recipients with sepsis through modulation of the inflammatory response.

KW - mortality

KW - sepsis

KW - transplantation

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U2 - 10.1093/cid/ciu789

DO - 10.1093/cid/ciu789

M3 - Article

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VL - 60

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JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

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