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Sepsis increases the risk of in-hospital cardiac arrest: a population-based analysis

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Abstract

Sepsis patients have a high risk of developing in-hospital cardiac arrest (IHCA), which portends poor survival. However, little is known about whether the increased incidence of IHCA is due to sepsis itself or to comorbidities harbored by sepsis patients. We conducted a retrospective population-based cohort study comprising 20,022 patients admitted with sepsis to hospitals in Taiwan using the National Health Insurance Research Database (NHIRD). We constructed three non-sepsis comparison cohorts using risk set sampling and propensity score (PS) matching. We used univariate conditional logistic regression to evaluate the risk of IHCA and associated mortality. We identified 12,790 inpatients without infection (matched cohort 1), 12,789 inpatients with infection but without sepsis (matched cohort 2), and 10,536 inpatients with end-organ dysfunction but without sepsis (matched cohort 3). In the three PS-matched cohorts, the odds ratios (OR) for developing ICHA were 21.17 (95% CI 17.19, 26.06), 18.96 (95% CI: 15.56, 23.10), and 1.23 (95% CI: 1.13, 1.33), respectively (p < 0.001 for all ORs). In conclusion, in our study of inpatients across Taiwan, sepsis was independently associated with an increased risk of IHCA. Further studies should focus on identifying the proxy causes of IHCA using real-time monitoring data to further reduce the incidence of cardiopulmonary insufficiency in patients with sepsis.

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Availability of data and materials

The datasets used during the current study are available from the corresponding author (C–CL) upon reasonable request.

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Acknowledgements

We thank the staff of the Core Labs, the Department of Medical Research, and National Taiwan University Hospital for technical support, and Clinical AI Consulting Group, LLC, USA for technical assistance in statistical analysis

Funding

This study was funded by National Science and Technology Council (NSTC) Grants NSTC 111-2622-8-002-031, NSTC 112-2321-B-002-013, and NSTC 110-2314-B-002–053-MY3, National Taiwan University Hospital (NTUH) Grant NTUH  112-UN0070, and Far Eastern Memorial Hospital (FEMH) Grant FEMH-2023-C-014. No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Ye Liu and Chia-Hung Yo have contribute equally to this work.

Authors and Affiliations

  1. Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Ye Liu

  2. Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan

    Chia-Hung Yo

  3. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA

    Jiun-Ruey Hu

  4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Wan-Ting Hsu

  5. Department of Pediatrics, Jefferson Einstein Hospital, Philadelphia, PA, USA

    Jo-Ching Hsiung

  6. Department of Biostatistics, University of California, Los Angeles, Los Angeles, USA

    Yung-Han Chang

  7. Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Shyr-Chyr Chen & Chien-Chang Lee

  8. The Centre for Intelligent Healthcare, College of Medicine, National Taiwan University Hospital, National Taiwan University, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan

    Chien-Chang Lee

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Contributions

YL drafted the manuscript, interpretation of the data, and critical revision of the manuscript for important intellectual content. C-HY was responsible for drafting the manuscript, interpretation of the data, and critical revision of the manuscript. J-RH and J-CH were responsible for critical revision of the manuscript for important intellectual content. W-TH and Y-HC were responsible for statistical analysis and critical revision of the manuscript for important intellectual content. S-CC provided critical feedback, and critically revised the manuscript. C–CL has full access to all data and is responsible for every aspect of the study, including the analysis, design, critical revisions, funding, and supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Chien-Chang Lee.

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The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at National Taiwan University Hospital, which waived the requirement for informed consent from patients because of the anonymous nature of the data.

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Liu, Y., Yo, CH., Hu, JR. et al. Sepsis increases the risk of in-hospital cardiac arrest: a population-based analysis. Intern Emerg Med 19, 353–363 (2024). https://doi.org/10.1007/s11739-023-03475-6

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  • DOI: https://doi.org/10.1007/s11739-023-03475-6

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