title: Is bacteremic sepsis associated with higher mortality in transplant recipients than in nontransplant patients? A matched case-control propensity-adjusted study.
abstract: BACKGROUND
  Sepsis is a serious complication of solid organ transplant (SOT). Evidence on survival differences between SOT recipients and non-SOT patients with sepsis is lacking.
  
  
  METHODS
  This was a matched, case-control propensity-adjusted study. Conditional logistic regression was performed for risk factor analysis, and Cox proportional hazards regression for survival analysis.
  
  
  RESULTS
  Three hundred sixty-nine patients (123 cases; 246 controls) diagnosed with blood culture-proven sepsis were matched 1:2 by age, sex, and hospital location. The distribution of allografts was 36.6% kidney, 34.1% liver, 13% kidney-pancreas, 7.3% small bowel/liver, 5.7% heart/lung, and 3.3% multivisceral. The conditional logistic regression showed that the following factors were significantly more frequently associated with SOT compared to non-SOT: higher number of comorbidities (odds ratio [OR] = 8.2 [95% confidence interval {CI}, 1.48-45.44], P = .016); higher Sepsis-related Organ Failure Assessment score (OR = 1.2 [95% CI, 1.07-1.32], P = .001); presence of nosocomial infection (OR = 36.3 [95% CI, 9.71-135.96], P < .0001); appropriate initial antibiotics (OR = 0.04 [95% CI, .006-.23], P < .0001); and lower white blood cell count (OR = 0.93 [95% CI, .89-.97], P < .0001). Cox proportional hazards regression showed that after all adjustments for clinical presentation, severity of illness, and types of infection, SOT recipients with sepsis had a significantly lower risk of death at 28 days (hazard ratio [HR] = 0.22 [95% CI, .09-.54], P = .001) and at 90 days (HR = 0.43 [95% CI, .20-.89], P = .025).
  
  
  CONCLUSIONS
  The 28-day and 90-day mortality were significantly decreased for transplant recipients compared with nontransplant patients. These findings suggest that the immunosuppression associated with transplantation may provide a survival advantage to transplant recipients with sepsis through modulation of the inflammatory response.
authors.affiliation: Division of Infectious Diseases, University of Nebraska Medical Center, Omaha.
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.affiliation: Infectious Diseases, Lakeshore Medical Group, Milwaukee, Wisconsin.
authors.forename: Ather
authors.initials: A
authors.lastname: Syed
authors.affiliation: Division of Infectious Diseases, University of Nebraska Medical Center, Omaha.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rupp
authors.affiliation: Division of Infectious Diseases, University of Nebraska Medical Center, Omaha.
authors.forename: Heather
authors.initials: H
authors.lastname: Chambers
authors.affiliation: Division of Transplant Surgery.
authors.forename: Luciano
authors.initials: L
authors.lastname: Vargas
authors.affiliation: Division of Transplant Surgery.
authors.forename: Alexander
authors.initials: A
authors.lastname: Maskin
authors.affiliation: Division of Nephrology, University of Nebraska Medical Center, Omaha.
authors.forename: Clifford D
authors.initials: CD
authors.lastname: Miles
authors.affiliation: Division of Transplant Surgery.
authors.forename: Alan
authors.initials: A
authors.lastname: Langnas
authors.affiliation: Division of Infectious Diseases, University of Nebraska Medical Center, Omaha Division of Transplant Surgery.
authors.forename: Diana F
authors.initials: DF
authors.lastname: Florescu
mesh_terms: D016470:Bacteremia / Q000401:mortality*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: mortality; sepsis; transplantation