nach oben

Erschienen in:

09.08.2021 | Systematic Review

Association between sepsis survivorship and long-term cardiovascular outcomes in adults: a systematic review and meta-analysis

verfasst von: Leah B. Kosyakovsky, Federico Angriman, Emma Katz, Neill K. Adhikari, Lucas C. Godoy, John C. Marshall, Bruno L. Ferreyro, Douglas S. Lee, Robert S. Rosenson, Naveed Sattar, Subodh Verma, Augustin Toma, Marina Englesakis, Barry Burstein, Michael E. Farkouh, Margaret Herridge, Dennis T. Ko, Damon C. Scales, Michael E. Detsky, Lior Bibas, Patrick R. Lawler

Erschienen in: Intensive Care Medicine | Ausgabe 9/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

We aimed to determine the association between sepsis and long-term cardiovascular events.

Methods

We conducted a systematic review of observational studies evaluating post-sepsis cardiovascular outcomes in adult sepsis survivors. MEDLINE, Embase, and the Cochrane Controlled Trials Register and Database of Systematic Reviews were searched from inception until April 21st, 2021. Two reviewers independently extracted individual study data and evaluated risk of bias. Random-effects models estimated the pooled crude cumulative incidence and adjusted hazard ratios (aHRs) of cardiovascular events compared to either non-septic hospital survivors or population controls. Primary outcomes included myocardial infarction, stroke, and congestive heart failure; outcomes were analysed at maximum reported follow-up (from 30 days to beyond 5 years post-discharge).

Results

Of 12,649 screened citations, 27 studies (25 cohort studies, 2 case-crossover studies) were included with a median of 4,289 (IQR 502–68,125) sepsis survivors and 18,399 (IQR 4,028–83,506) controls per study. The pooled cumulative incidence of myocardial infarction, stroke, and heart failure in sepsis survivors ranged from 3 to 9% at longest reported follow-up. Sepsis was associated with a higher long-term risk of myocardial infarction (aHR 1.77 [95% CI 1.26 to 2.48]; low certainty), stroke (aHR 1.67 [95% CI 1.37 to 2.05]; low certainty), and congestive heart failure (aHR 1.65 [95% CI 1.46 to 1.86]; very low certainty) compared to non-sepsis controls.

Conclusions

Surviving sepsis may be associated with a long-term, excess hazard of late cardiovascular events which may persist for at least 5 years following hospital discharge.

Nur mit Berechtigung zugänglich

Rudd KE, Johnson SC, Agesa KM et al (2020) Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet 395:200–211. https://doi.org/10.1016/S0140-6736(19)32989-7CrossRefPubMedPubMedCentral

Prescott HC, Angus DC (2018) Enhancing recovery from sepsis: a review. JAMA - J Am Med Assoc 319:62–75. https://doi.org/10.1001/jama.2017.17687CrossRef

Mankowski RT, Yende S, Angus DC (2019) Long-term impact of sepsis on cardiovascular health. Intensive Care Med 45:78–81. https://doi.org/10.1007/s00134-018-5173-1CrossRefPubMed

Rahmel T, Schmitz S, Nowak H et al (2020) Long-term mortality and outcome in hospital survivors of septic shock, sepsis, and severe infections: the importance of aftercare. PLoS ONE. https://doi.org/10.1371/journal.pone.0228952CrossRefPubMedPubMedCentral

Shankar-Hari M, Rubenfeld GD (2016) Understanding long-term outcomes following sepsis: implications and challenges. Curr Infect Dis Rep 18:37. https://doi.org/10.1007/s11908-016-0544-7CrossRefPubMedPubMedCentral

Prescott HC, Osterholzer JJ, Langa KM et al (2016) Late mortality after sepsis: propensity matched cohort study. BMJ 353:1–8. https://doi.org/10.1136/bmj.i2375CrossRef

Lone NI, Gillies MA, Haddow C et al (2016) Five-year mortality and hospital costs associated with surviving intensive care. Am J Respir Crit Care Med 194:198–208. https://doi.org/10.1164/rccm.201511-2234OCCrossRefPubMedPubMedCentral

Mostel Z, Perl A, Marck M et al (2019) Post-sepsis syndrome—an evolving entity that afflicts survivors of sepsis. Mol Med. https://doi.org/10.1186/s10020-019-0132-zCrossRefPubMedPubMedCentral

Cuthbertson BH, Elders A, Hall S et al (2013) Mortality and quality of life in the five years after severe sepsis. Crit Care 17:R70. https://doi.org/10.1186/cc12616CrossRefPubMedPubMedCentral

10.

Nesseler N, Defontaine A, Launey Y et al (2013) Long-term mortality and quality of life after septic shock: a follow-up observational study. Intensive Care Med 39:881–888. https://doi.org/10.1007/s00134-013-2815-1CrossRefPubMed

11.

Levy MM, Rhodes A, Phillips GS et al (2015) Surviving sepsis campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med 43:3–12. https://doi.org/10.1097/CCM.0000000000000723CrossRefPubMed

12.

Yende S, D’Angelo G, Mayr F et al (2011) Elevated hemostasis markers after pneumonia increases one-year risk of all-cause and cardiovascular deaths. PLoS ONE. https://doi.org/10.1371/journal.pone.0022847CrossRefPubMedPubMedCentral

13.

Yende S, D’Angelo G, Kellum JA et al (2008) Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med 177:1242–1247. https://doi.org/10.1164/rccm.200712-1777OCCrossRefPubMedPubMedCentral

14.

Yende S, Kellum JA, Talisa VB et al (2019) Long-term host immune response trajectories among hospitalized patients with sepsis. JAMA Netw Open 2:1–15. https://doi.org/10.1001/jamanetworkopen.2019.8686CrossRef

15.

Mira JC, Gentile LF, Mathias BJ et al (2017) Sepsis pathophysiology, chronic critical illness, and persistent inflammation-immunosuppression and catabolism syndrome. Crit Care Med 45:253–262. https://doi.org/10.1097/CCM.0000000000002074CrossRefPubMedPubMedCentral

16.

Lawler PR, Bhatt DL, Godoy LC et al (2021) Targeting cardiovascular inflammation: next steps in clinical translation. Eur Hear J 42(1):113–131. https://doi.org/10.1093/eurheartj/ehaa099CrossRef

17.

Musher DM, Abers MS, Corrales-Medina VF (2019) Acute infection and myocardial infarction. N Engl J Med 380:171–176. https://doi.org/10.1056/NEJMra1808137CrossRefPubMed

18.

Corrales-Medina VF, Alvarez KN, Weissfeld LA et al (2015) Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA - J Am Med Assoc 313:264–274. https://doi.org/10.1001/jama.2014.18229CrossRef

19.

Yende S, Linde-Zwirble W, Mayr F et al (2014) Risk of cardiovascular events in survivors of severe sepsis. Am J Respir Crit Care Med 189:1065–1074. https://doi.org/10.1164/rccm.201307-1321OCCrossRefPubMedPubMedCentral

20.

Lai CC, Lee MTG, Lee WC et al (2018) Susceptible period for cardiovascular complications in patients recovering from sepsis. CMAJ 190:E1062–E1069. https://doi.org/10.1503/cmaj.171284CrossRefPubMedPubMedCentral

21.

Ou S-MM, Chu H, Chao P-WW et al (2016) Long-term mortality and major adverse cardiovascular events in sepsis survivors a nationwide population-based study. Am J Respir Crit Care Med 194:209–217. https://doi.org/10.1164/rccm.201510-2023OCCrossRefPubMed

22.

De Geer L, Oscarsson Tibblin A, Fredrikson M, Walther SM (2019) No association with cardiac death after sepsis: a nationwide observational cohort study. Acta Anaesthesiol Scand 63:344–351. https://doi.org/10.1111/aas.13280CrossRefPubMed

23.

Kosyakovsky LB, Angriman F, Katz E et al (2020) Abstract 13315: long-term risk of cardiovascular events following hospitalization for sepsis: a systematic review and meta-analysis. Circulation 142:A13315CrossRef

24.

Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology. A proposal for reporting. JAMA 283:2008–2012. https://doi.org/10.1001/jama.283.15.2008CrossRefPubMed

25.

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. https://doi.org/10.1371/journal.pmed.1000097CrossRefPubMedPubMedCentral

26.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ WV (editors) (2020) Cochrane handbook for systematic reviews of interventions version 6.1 (updated September 2020). In: Cochrane. https://training.cochrane.org/handbook. Accessed 7 Jul 2020

27.

Bouza C, Lopez-Cuadrado T, Amate-Blanco JM (2016) Use of explicit ICD9-CM codes to identify adult severe sepsis: impacts on epidemiological estimates. Crit Care 20:313. https://doi.org/10.1186/s13054-016-1497-9CrossRefPubMedPubMedCentral

28.

Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA - J Am Med Assoc 315:801–810. https://doi.org/10.1001/jama.2016.0287CrossRef

29.

Jolley RJ, Sawka KJ, Yergens DW et al (2015) Validity of administrative data in recording sepsis: a systematic review. Crit Care 19:139. https://doi.org/10.1186/s13054-015-0847-3CrossRefPubMedPubMedCentral

30.

Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158(4):280–286. https://doi.org/10.7326/0003-4819-158-4-201302190-00009CrossRefPubMed

31.

Foroutan F, Guyatt G, Zuk V et al (2020) GRADE Guidelines 28: use of GRADE for the assessment of evidence about prognostic factors: rating certainty in identification of groups of patients with different absolute risks. J Clin Epidemiol 121:62–70. https://doi.org/10.1016/j.jclinepi.2019.12.023CrossRefPubMed

32.

Jackson D, Law M, Rücker G, Schwarzer G (2017) The Hartung-Knapp modification for random-effects meta-analysis: a useful refinement but are there any residual concerns? Stat Med 36:3923–3934. https://doi.org/10.1002/sim.7411CrossRefPubMedPubMedCentral

33.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188. https://doi.org/10.1016/0197-2456(86)90046-2CrossRefPubMed

34.

Tierney JF, Stewart LA, Ghersi D et al (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 8:16. https://doi.org/10.1186/1745-6215-8-16CrossRefPubMedPubMedCentral

35.

Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. Br Med J 327:557–560. https://doi.org/10.1136/bmj.327.7414.557CrossRef

36.

Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088. https://doi.org/10.2307/2533446CrossRefPubMed

37.

Viechtbauer W, Cheung MW-L (2010) Outlier and influence diagnostics for meta-analysis. Res Synth Methods 1:112–125. https://doi.org/10.1002/jrsm.11CrossRefPubMed

38.

Mathur MB, VanderWeele TJ (2020) Sensitivity analysis for unmeasured confounding in meta-analyses. J Am Stat Assoc 115:163–172. https://doi.org/10.1080/01621459.2018.1529598CrossRefPubMed

39.

Wang HE, Moore JX, Donnelly JP et al (2017) Risk of acute coronary heart disease after sepsis hospitalization in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort. Clin Infect Dis 65:29–36. https://doi.org/10.1093/cid/cix248CrossRefPubMedPubMedCentral

40.

Chang DW, Tseng CH, Shapiro MF (2015) Rehospitalizations following sepsis: common and costly. Crit Care Med 43:2085–2093. https://doi.org/10.1097/CCM.0000000000001159CrossRefPubMedPubMedCentral

41.

Cheng CA, Cheng CG, Lin HC et al (2017) New-onset atrial fibrillation-related ischemic stroke occurring after hospital discharge in septicemia survivors. QJM 110:447–452. https://doi.org/10.1093/qjmed/hcx025CrossRef

42.

Corrales-Medina VF, Taljaard M, Yende S et al (2015) Intermediate and long-term risk of new-onset heart failure after hospitalization for pneumonia in elderly adults. Am Heart J 170:306-312.e6. https://doi.org/10.1016/j.ahj.2015.04.028CrossRefPubMedPubMedCentral

43.

Prescott HC (2017) Variation in postsepsis readmission patterns: a cohort study of veterans affairs beneficiaries. Ann Am Thorac Soc 14:230–237. https://doi.org/10.1513/AnnalsATS.201605-398OCCrossRefPubMedPubMedCentral

44.

Ishani A, Collins AJ, Herzog CA, Foley RN (2005) Septicemia, access and cardiovascular disease in dialysis patients: the USRDS Wave 2 Study. Kidney Int 68:311–318. https://doi.org/10.1111/j.1523-1755.2005.00414.xCrossRefPubMed

45.

Jafarzadeh SR, Thomas BS, Warren DK et al (2016) Longitudinal study of the effects of bacteremia and sepsis on 5-year risk of cardiovascular events. Clin Infect Dis 63:495–500. https://doi.org/10.1093/cid/ciw320CrossRefPubMedPubMedCentral

46.

Abramovich E, Barrett O, Dreiher J et al (2018) Incidence and variables associated with short and long-term mortality in patients with systemic lupus erythematosus and sepsis admitted in intensive care units. Lupus 27:1936–1943. https://doi.org/10.1177/0961203318796288CrossRefPubMed

47.

Wu MH, Tsou PY, Wang YH et al (2019) Impact of post-sepsis cardiovascular complications on mortality in sepsis survivors: a population-based study. Crit Care 23:1–11. https://doi.org/10.1186/s13054-019-2579-2CrossRef

48.

Gupta VA, Sousa M, Kraitman N et al (2018) Coronary artery calcification predicts cardiovascular complications after sepsis. J Crit Care 44:261–266. https://doi.org/10.1016/j.jcrc.2017.11.038CrossRefPubMed

49.

Lee JT, Chung WT, Lin JD et al (2014) Increased risk of stroke after septicaemia: a population-based longitudinal study in Taiwan. PLoS ONE. https://doi.org/10.1371/journal.pone.0089386CrossRefPubMedPubMedCentral

50.

Aldás I, Menéndez R, Méndez R et al (2019) Early and late cardiovascular events in patients hospitalized for community-acquired pneumonia. Arch Bronconeumol 56:551–558. https://doi.org/10.1016/j.arbres.2019.10.009CrossRefPubMed

51.

Alnabelsi TS, Gupta VA, Su LC et al (2020) Usefulness of findings by multimodality imaging to stratify risk of major adverse cardiac events after sepsis at 1 and 12 months. Am J Cardiol 125:1732–1737. https://doi.org/10.1016/j.amjcard.2020.02.015CrossRefPubMed

52.

Boehme AK, Ranawat P, Luna J et al (2017) Risk of acute stroke after hospitalization for sepsis: a case-crossover study. Stroke 48:574–580. https://doi.org/10.1161/STROKEAHA.116.016162CrossRefPubMedPubMedCentral

53.

Sebastian S, Stein LK, Dhamoon MS (2019) Infection as a stroke trigger: associations between different organ system infection admissions and stroke subtypes. Stroke 50:2216–2218. https://doi.org/10.1161/STROKEAHA.119.025872CrossRefPubMed

54.

Shih CJ, Chao PW, Ou SM, Chen YT (2017) Long-term risk of cardiovascular events in patients with chronic kidney disease who have survived sepsis: a nationwide cohort study. J Am Heart Assoc. https://doi.org/10.1161/JAHA.116.004613CrossRefPubMedPubMedCentral

55.

Vallabhajosyula S, Jentzer JC, Geske JB et al (2018) New-onset heart failure and mortality in hospital survivors of sepsis-related left ventricular dysfunction. Shock 49:144–149. https://doi.org/10.1097/SHK.0000000000000952CrossRefPubMedPubMedCentral

56.

Walkey AJ, Hammill BG, Curtis LH, Benjamin EJ (2014) Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest 146:1187–1195. https://doi.org/10.1378/chest.14-0003CrossRefPubMedPubMedCentral

57.

Donzé JD, Ridker PM, Finlayson SRG, Bates DW (2014) Impact of sepsis on risk of postoperative arterial and venous thromboses: large Prospective cohort study. BMJ 349:1–10. https://doi.org/10.1136/bmj.g5334CrossRef

58.

Gadre SK, Shah M, Mireles-Cabodevila E et al (2019) Epidemiology and predictors of 30-day readmission in patients with sepsis. Chest 155:483–490. https://doi.org/10.1016/j.chest.2018.12.008CrossRefPubMed

59.

Beesley SJ, Sorensen J, Walkey AJ et al (2021) Long-term implications of abnormal left ventricular strain during sepsis. Crit Care Med 49(4):e444–e453. https://doi.org/10.1097/CCM.0000000000004886CrossRefPubMedPubMedCentral

60.

Gupta VA, Alnabelsi TS, Shringi S, Leung SW, Sorrell VL (2020) Cardiovascular risk after sepsis: understanding the role of statin indications and the impact of clinical inertia on prescribing patterns. J Cardiovasc Pharmacol Ther 25(6):541–547. https://doi.org/10.1177/1074248420933395CrossRefPubMed

61.

Virani SS, Alonso A, Benjamin EJ et al (2020) Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation 141:E139–E596. https://doi.org/10.1161/CIR.0000000000000757CrossRefPubMed

62.

Carroll MD, Lacher DA, Sorlie PD et al (2005) Trends in serum lipids and lipoproteins of adults, 1960–2002. J Am Med Assoc 294:1773–1781. https://doi.org/10.1001/jama.294.14.1773CrossRef

63.

Kwong JC, Schwartz KL, Campitelli MA et al (2018) Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med 378(4):345–353. https://doi.org/10.1056/NEJMoa1702090CrossRefPubMed

64.

Hawkins RB, Raymond SL, Stortz JA et al (2018) Chronic critical illness and the persistent inflammation, immunosuppression, and catabolism syndrome. Front Immunol. https://doi.org/10.3389/fimmu.2018.01511CrossRefPubMedPubMedCentral

65.

Merx MW, Weber C (2007) Sepsis and the heart. Circulation 116:793–802. https://doi.org/10.1161/CIRCULATIONAHA.106.678359CrossRefPubMed

66.

Kaynar AM, Yende S, Zhu L et al (2014) Effects of intra-abdominal sepsis on atherosclerosis in mice. Crit Care. https://doi.org/10.1186/s13054-014-0469-1CrossRefPubMedPubMedCentral

67.

Foley JH, Conway EM (2016) Cross talk pathways between coagulation and inflammation. Circ Res 118:1392–1408. https://doi.org/10.1161/CIRCRESAHA.116.306853CrossRefPubMed

68.

Lawler PR, Akinkuolie AO, Chandler PD et al (2016) Circulating N-linked glycoprotein acetyls and longitudinal mortality risk. Circ Res 118:1106–1115. https://doi.org/10.1161/CIRCRESAHA.115.308078CrossRefPubMedPubMedCentral

69.

Liuzzo G, Angiolillo DJ, Buffon A et al (2001) Enhanced response of blood monocytes to in vitro lipopolysaccharide-challenge in patients with recurrent unstable angina. Circulation 103:2236–2241. https://doi.org/10.1161/01.CIR.103.18.2236CrossRefPubMed

70.

Krumholz HM (2013) Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med 368:100–102. https://doi.org/10.1056/NEJMp1212324CrossRefPubMedPubMedCentral

71.

Seymour CW, Kennedy JN, Wang S et al (2019) Derivation, validation, and potential treatment implications of novel clinical phenotypes for sepsis. JAMA - J Am Med Assoc 321:2003–2017. https://doi.org/10.1001/jama.2019.5791CrossRef

72.

Cherney DZI, Rosenson RS, Lawler PR (2019) Atherosclerotic cardiovascular disease and chronic kidney disease: an emerging role for evolocumab? J Am Coll Cardiol 73:2971–2975. https://doi.org/10.1016/j.jacc.2019.03.514CrossRefPubMed

73.

Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496. https://doi.org/10.2307/2670170CrossRef

Titel: Association between sepsis survivorship and long-term cardiovascular outcomes in adults: a systematic review and meta-analysis
verfasst von: Leah B. Kosyakovsky
Federico Angriman
Emma Katz
Neill K. Adhikari
Lucas C. Godoy
John C. Marshall
Bruno L. Ferreyro
Douglas S. Lee
Robert S. Rosenson
Naveed Sattar
Subodh Verma
Augustin Toma
Marina Englesakis
Barry Burstein
Michael E. Farkouh
Margaret Herridge
Dennis T. Ko
Damon C. Scales
Michael E. Detsky
Lior Bibas
Patrick R. Lawler
Publikationsdatum: 09.08.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 9/2021
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-021-06479-y

Neu im Fachgebiet AINS

Delir bei kritisch Kranken – Antipsychotika versus Placebo

16.05.2024 Delir Nachrichten

Um die Langzeitfolgen eines Delirs bei kritisch Kranken zu mildern, wird vielerorts auf eine Akuttherapie mit Antipsychotika gesetzt. Eine US-amerikanische Forschungsgruppe äußert jetzt erhebliche Vorbehalte gegen dieses Vorgehen. Denn es gibt neue Daten zum Langzeiteffekt von Haloperidol bzw. Ziprasidon versus Placebo.

Eingreifen von Umstehenden rettet vor Erstickungstod

15.05.2024 Fremdkörperaspiration Nachrichten

Wer sich an einem Essensrest verschluckt und um Luft ringt, benötigt vor allem rasche Hilfe. Dass Umstehende nur in jedem zweiten Erstickungsnotfall bereit waren, diese zu leisten, ist das ernüchternde Ergebnis einer Beobachtungsstudie aus Japan. Doch es gibt auch eine gute Nachricht.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Association between sepsis survivorship and long-term cardiovascular outcomes in adults: a systematic review and meta-analysis