title: Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis.
abstract: BACKGROUND
  Sepsis is currently the leading cause of direct maternal death in the United Kingdom. In this study, we aimed to determine frequency, temporal trends, and independent associations for severe sepsis during hospitalization for delivery in the United States.
  
  
  METHODS
  Data were obtained from the Nationwide Inpatient Sample for the years 1998 through 2008. The presence of severe sepsis was identified by the appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Logistic regression analysis was used to assess temporal trends for sepsis, severe sepsis, and sepsis-related death and also to identify independent associations of severe sepsis.
  
  
  RESULTS
  Of an estimated 44,999,260 hospitalizations for delivery, sepsis complicated 1:3333 (95% confidence interval [CI], 1:3151-1:3540) deliveries, severe sepsis complicated 1:10,823 (95% CI, 1:10,000-1:11,792) deliveries, and sepsis-related death complicated 1:105,263 (95% CI, 1:83,333-1:131,579) deliveries. While the overall frequency of sepsis was stable(P = 0.95), the risk of severe sepsis and sepsis-related death increased during the study period, (P < 0.001) and (P = 0.02), respectively. Independent associations for severe sepsis, with an adjusted odds ratio and lower bound 95% CI higher than 3, include congestive heart failure, chronic liver disease, chronic renal disease, systemic lupus erythematous, and rescue cerclage placement.
  
  
  CONCLUSIONS
  Maternal severe sepsis and sepsis-related deaths are increasing in the United States. Severe sepsis often occurs in the absence of a recognized risk factor and underscores the need for developing systems of care that increase sensitivity for disease detection across the entire population. Physicians should enhance surveillance in patients with congestive heart failure, chronic liver disease, chronic renal disease, and systemic lupus erythematous and institute early treatment when signs of sepsis are emerging.
authors.affiliation: From the Department of Anesthesiology, Division of Obstetric Anesthesia, University of Michigan Health System, Ann Arbor, Michigan; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital; Department of Medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak; and Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Bauer
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bateman
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Bauer
authors.forename: Amy M
authors.initials: AM
authors.lastname: Shanks
authors.forename: Jill M
authors.initials: JM
authors.lastname: Mhyre
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000401:mortality* / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008428:Maternal Mortality / Q000639:trends; D011247:Pregnancy; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality*; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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