title: Long-Term Risk of Cardiovascular Events in Patients With Chronic Kidney Disease Who Have Survived Sepsis: A Nationwide Cohort Study.
abstract: Long-term cardiovascular outcomes after sepsis in patients with chronic kidney disease are not well known. We aimed to examine the risk of subsequent cardiovascular events in patients with chronic kidney disease discharged after hospitalization for sepsis in Taiwan.
  
  
  
  Using complete claims data for patients with chronic kidney disease from Taiwan's National Health Insurance Research Database, we identified patients with sepsis who survived hospitalization between 2000 and 2010. Each sepsis survivor was propensity score-matched to one nonsepsis hospitalized control patient. Cox regression models were used to estimate the hazard ratios (HRs) of clinical outcomes, including major adverse cardiovascular events (myocardial infarction and ischemic stroke), hospitalization for heart failure, and all-cause death. Among 66 961 sepsis survivors, the incidence rates of all-cause mortality and major adverse cardiovascular events during the study period were 288.51 and 47.05 per 1000 person-years, respectively. In comparison with matched hospitalized nonsepsis control patients, sepsis survivors had greater risks of major adverse cardiovascular events (HR, 1.42; 95% CI, 1.37-1.47), myocardial infarction (HR, 1.39; 95% CI, 1.32-1.47), ischemic stroke (HR, 1.46; 95% CI, 1.40-1.52), hospitalization for heart failure (HR, 1.55; 95% CI, 1.51-1.59), and all-cause mortality (HR, 1.56; 95% CI, 1.54-1.58). The results remained unchanged in analyses of several subgroups of patients, and were similar in analyses accounting for the competing risk of death.
  
  
  
  Our findings highlight the association of sepsis with a significantly increased long-term risk of cardiovascular events among survivors in the chronic kidney disease population.
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Deran Clinic, Yilan, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Shih
authors.affiliation: School of Medicine, College, Taipei Medical University, Taipei, Taiwan.|Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Chao
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ytchen0117@gmail.com okokyytt@gmail.com.|Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan ytchen0117@gmail.com okokyytt@gmail.com.|Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011379:Prognosis; D051436:Renal Insufficiency, Chronic; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D017741:Survivors / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: cardiovascular events; chronic kidney disease; epidemiology; infection; sepsis