At hospitals seeing fewer than 225 immunosuppressed patients with sepsis each year, these patients were 38% more likely to die while hospitalized, compared to 21% more likely to die at hospitals that saw 225 or more of these patients yearly.
"While there is a lot of focus on improving sepsis outcomes through early interventions, some patients have poor outcomes from sepsis because their chronic medical conditions may worsen after the initial infectious insult," said study author Jared A. Greenberg, MD an assistant professor and critical care physician at Rush University Medical Center in Chicago.
"We hypothesized that septic patients who are immunocompromised may have improved outcomes if they are managed at hospitals that have the most experience managing immunocompromising conditions," Greenberg said in comments accompanying the study.
The researchers analyzed medical records of 350,183 patients with sepsis at 60 hospitals. One of five of those patients was classified as being immunocompromised based on being HIV-positive or having an intrinsic immune disorder, having a blood cancer or being prescribed an immunosuppressive drug for certain medical conditions while hospitalized.
The study found:
- 15% of immunosuppressed patients with sepsis died during hospitalization compared to 12% of non-immunosuppressed patients with sepsis at all hospitals.
- At hospitals seeing fewer than 225 immunosuppressed patients with sepsis each year, these patients were 38% more likely to die while hospitalized, compared to 21% more likely to die at hospitals that saw 225 or more of these patients yearly.
- Above 225, caring for greater numbers of immunosuppressed patients with sepsis (one hospital treated 1,056 such patients) did not appear to reduce mortality.
- Immunosuppressed patients with sepsis were more likely than non- immunosuppressed patients to return to their homes after discharge, rather than another health facility, 60% vs. 50%, respectively.
Greenberg said the last finding was a surprise. He said non-immunosuppressed patients may have been in declining health before sepsis than immunosuppressed patients, as they were more likely to be older and to be admitted directly from other healthcare facilities.
The study does not explain why survival rates are higher in hospitals that treat more immunosuppressed sepsis patients, but the authors speculate that "immunosuppressed patients with sepsis had improved survival at hospitals where clinicians had greater familiarity caring for immunosuppressed patients."
Sepsis kills 258,000 people each year in the United States and costs more than $24 billion. It represents 6.2% of all hospital costs across the nation, which makes it the most expensive condition in the nation's healthcare system, according to the federal government's Healthcare Cost and Utilization Project.