title: Trends and Outcomes of Severe Sepsis in Patients on Maintenance Dialysis.
abstract: BACKGROUND
  Though the incidence of severe sepsis is rising, there is a lack of contemporary information regarding the epidemiology and outcomes of severe sepsis in those on maintenance dialysis. The objectives of this study were to measure the incidence and outcomes of severe sepsis in those on maintenance dialysis.
  
  
  METHODS
  Using data from Nationwide Inpatient Sample database from 2005 to 2010, we included all hospitalizations of adults with severe sepsis based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Those on maintenance dialysis were identified by ICD-9-CM codes. We calculated incidence of severe sepsis and mortality. We used logistic regression to assess independent effect of maintenance dialysis status on mortality.
  
  
  RESULTS
  Of the estimated 5,000,152 hospitalizations with severe sepsis, 322,734 (6.4%) were on maintenance dialysis. The unadjusted incidence of severe sepsis was 145.4 per 1,000 in those on maintenance dialysis in comparison to 3.5 per 1,000 in the general population. Mortality was higher in those with severe sepsis (30.3 vs. 26.2%; p < 0.001). Maintenance dialysis is an independent predictor of death in those with severe sepsis (OR 1.26; 95% CI 1.23-1.29).
  
  
  CONCLUSIONS
  Hospitalizations with severe sepsis are more prevalent and associated with poor outcomes in those on maintenance dialysis.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Misc., USA.
authors.forename: Ankit
authors.initials: A
authors.lastname: Sakhuja
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Nanchal
authors.forename: Shipra
authors.initials: S
authors.lastname: Gupta
authors.forename: Hatem
authors.initials: H
authors.lastname: Amer
authors.forename: Gagan
authors.initials: G
authors.lastname: Kumar
authors.forename: Robert C
authors.initials: RC
authors.lastname: Albright
authors.forename: Kianoush B
authors.initials: KB
authors.lastname: Kashani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology