title: Inpatient Mortality Among Solid Organ Transplant Recipients Hospitalized for Sepsis and Severe Sepsis.
abstract: Solid organ transplant (SOT) recipients are at elevated risk of sepsis. The impact of SOT on outcomes following sepsis is unclear.
  
  
  
  We performed a retrospective cohort study using data from University HealthSystem Consortium, a consortium of academic medical center affiliates. We examined the association between SOT and mortality among patients hospitalized with severe sepsis or explicitly coded sepsis in 2012-2014. We used International Classification of Diseases, Ninth Revision (ICD-9) codes to identify severe sepsis, explicitly coded sepsis, and SOT (kidney, liver, heart, lung, pancreas, or intestine transplants). We fit random-intercept logistic regression models to account for clustering by hospital.
  
  
  
  There were 903 816 severe sepsis hospitalizations (39 618 [4.4%] with SOT) and 410 623 sepsis hospitalizations (14 526 [3.9%] with SOT) in 250 hospitals. SOT recipients were younger and more likely to be insured by Medicare than those without SOT. Among hospitalizations for severe sepsis and sepsis, in-hospital mortality was lower among those with vs those without SOT (5.5% vs 9.4% for severe sepsis; 8.7% vs 12.7% for sepsis). After adjustment, the odds ratio for mortality comparing SOT patients vs non-SOT was 0.83 (95% confidence interval [CI], .79-.87) for severe sepsis and 0.78 (95% CI, .73-.84) for sepsis. Compared to non-SOT patients, kidney, liver, and co-transplant (kidney-pancreas/kidney-liver) recipients demonstrated lower mortality. No association was present for heart transplant, and lung transplant was associated with higher mortality.
  
  
  
  Among patients hospitalized for severe sepsis or sepsis, those with SOT had lower inpatient mortality than those without SOT. Identifying the specific strategies employed for populations with improved mortality could inform best practices for sepsis among SOT and non-SOT populations.
authors.affiliation: Department of Emergency Medicine, School of Medicine Department of Medicine, Division of Preventive Medicine Department of Epidemiology, School of Public Health.
authors.forename: John P
authors.initials: JP
authors.lastname: Donnelly
authors.affiliation: Comprehensive Transplant Institute Department of Surgery, Division of Transplantation.
authors.forename: Jayme E
authors.initials: JE
authors.lastname: Locke
authors.affiliation: Comprehensive Transplant Institute Department of Surgery, Division of Transplantation.
authors.forename: Paul A
authors.initials: PA
authors.lastname: MacLennan
authors.affiliation: Department of Epidemiology, School of Public Health.
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.affiliation: Comprehensive Transplant Institute Department of Surgery, Division of Transplantation Department of Medicine, Division of Nephrology.
authors.forename: Roslyn B
authors.initials: RB
authors.lastname: Mannon
authors.affiliation: Department of Medicine Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham.
authors.forename: John W
authors.initials: JW
authors.lastname: Baddley
authors.affiliation: Department of Epidemiology, School of Public Health.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Department of Emergency Medicine, School of Medicine.
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000401:mortality*; D066027:Transplant Recipients
keywords: critical care; infection; outcomes; sepsis; transplant