First sepsis, then heart failure? – DocCheck

Sepsis can be fatal, even long after discharge from the hospital. You can read here how it increases the cardiovascular risk and what you have to watch out for.

Sepsis is one of the leading causes of hospital admissions worldwide. Even if intensive care medicine can bridge critical phases by temporarily replacing or supporting organ functions, the disease often leads to death. A current retrospective Study found that patients who were hospitalized for sepsis or developed it during an in-hospital stay had an increased risk of heart failure and increased risk of death.

Study with more than two million patients

The research group led by Prof. Jacob Jentzer from the Mayo Clinic in Rochester examined the risk of dying after discharge and of re-hospitalization due to cardiovascular diseases in patients suffering from sepsis. More than two million patients were included in the study. The research team used US insurance data from people with a non-surgical hospital stay of at least two nights.

Approximately 809,000 people with sepsis were compared to 1,450,000 hospitalized patients without sepsis who had cardiovascular disease or associated risk factors. The patients were between 19 and 87 years old. The follow-up period was a maximum of 12 years. Among those who fell ill were people with diagnosed sepsis or implicit sepsis defined as having an infection with organ failure. This was automatically noted as sepsis in the electronic medical records.

Infection as a potential trigger for heart attacks

Patients with sepsis had a significantly increased risk of death (27%), a significantly increased risk of hospitalization for any cause (38%), and a significantly increased risk of hospitalization for cardiovascular causes (43%) compared to those without sepsis over the following 12 years. ). The most common major cardiovascular event at follow-up in people with a history of sepsis was heart failure. Their risk was increased by 51% compared to people without sepsis during their hospital stay. Patients with implicit sepsis were twice as likely to be hospitalized for cardiovascular events as compared to patients who had explicit sepsis.

Jentzer et al. postulate that infection may be a potential trigger for myocardial infarction and may also predispose patients to other cardiovascular events, either during infection or later when its sequelae cause progressive cardiovascular disease. The risk of cardiovascular events in patients who survive sepsis is such that it should be considered a non-traditional risk factor for cardiovascular events, the authors said. Rather, the results of the study show that after hospitalization with sepsis, close follow-up is important and that it may be helpful to carry out cardiovascular preventive therapies under close supervision.

Correlation or causation? That question remains

Health care professionals should be aware of the high cardiovascular risk of people with sepsis and possibly step up prevention, the authors add. This idea is also shared by Dr. UC San Diego Health’s Gabriel Wardi in one voiceover supported for the study. He emphasizes that during the anamnesis patients should be asked about a history of surviving sepsis, as this could possibly improve the prognosis. However, he also points out the limitations of the study. Limitations included that the data was collected retrospectively and no information was available about the severity of the sepsis. The study design does not allow any conclusions about causality. It cannot therefore be conclusively clarified whether sepsis occurs in people with an increased risk of cardiovascular diseases or whether it directly increases the risk of such diseases.

If you take a look at the literature of the past few years, there are other studies that came to similar conclusions. For example, medical professionals from Taiwan retrospectively followed the course of more than 42,000 sepsis patients up to 180 days after they were discharged from the hospital. Primary endpoint of Study was the occurrence of a heart attack or stroke. During the observation period, 831 sepsis patients suffered a stroke and 184 a heart attack. The risk of suffering a heart attack or stroke was five times higher in patients with recovered sepsis in the first week after discharge than in the general population. Even after four weeks it was still more than doubled and then gradually converged towards the normal level.

Doctors should pay attention to sepsis

Unfortunately, however, the long-term course is missing in this study. A longer follow-up period offers a Study from the University of Örebro in 2017. The research team studied a cohort of 246,739 men born between 1952 and 1956. Just under a fifth (46,754 men) had received medical treatment for cardiovascular disease by 2010, 10,279 of them for coronary artery disease. A total of 301 men were hospitalized for either pneumonia or sepsis in the year prior to cardiovascular disease. Compared to those who had not experienced sepsis, the risk was more than sixfold. The researchers determine a hazard ratio of 6.33, which was significant with a 95 percent confidence interval of 5.65 to 7.09. In the second and third year after infection, the risk of cardiovascular disease was increased by a factor of 2.47 and 2.12, respectively. The risk gradually decreased in the years that followed. However, it remained significantly elevated by 87 percent five or more years after infection. The main limitation of this study is that only men were examined.

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Even if many questions are still unanswered, the results of the current study by Jentzer et al. lead to healthcare professionals listening carefully to an episode of sepsis as an important event in their patient’s medical history. It is possible that good long-term care and careful cardiovascular risk stratification can improve their prognosis.

Sources

Jentzer J et al., Cardiovascular Events Among Survivors of Sepsis Hospitalization: A Retrospective Cohort Analysis. Journal of the American Heart Association2023. https://doi.org/10.1161/JAHA.122.027813.

Wardi G et al., Describing Sepsis as a Risk Factor for Cardiovascular Disease. Journal of the American Heart Association2023. https://doi.org/10.1161/JAHA.122.028882.

Lai CC et al., CMAJ 2018 September 10; 190: E1062–9; doi.org/10.1503/cmaj.171284

Cecilia Bergh, Katja Fall, Ruzan Udumyan, Hugo Sjöqvist, Ole Fröbert, Scott Montgomery, Severe Infections and Subsequent Delayed Cardiovascular Disease, European Journal of Preventive CardiologyVolume 24, Issue 18, 1 December 2017, 1.958–1.966, https://doi.org/10.1177/2047487317724009.

Image source: jesse orrico, unsplash

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