title: The epidemiologic characteristics, temporal trends, predictors of death, and discharge disposition in patients with a diagnosis of sepsis: A cross-sectional retrospective cohort study.
abstract: To assess recent epidemiologic characteristics, temporal trends, and predictors of death and discharge disposition in patients with sepsis.
  
  
  
  This is a cross-sectional retrospective cohort study using the US National Inpatient Sample (NIS) data from 2009 to 2012. The study population included adults (18years and older) with sepsis-related International Classification of Diseases, Ninth Revision, Clinical Modification codes at the time of discharge. Factors associated with in-hospital mortality and patient discharge disposition were derived from multivariate analyses using multinomial logistic models by SAS PROC LOGISTIC with GLOGIT link.
  
  
  
  Of 1 303 640 patients admitted, 15% died, 30% were discharged to home without home care, 34% were transferred to a skilled outpatient facility, and 4% were transferred to another short-term hospital. In-hospital mortality decreased from 16.5% to 13.8% (P<.001) across time. Length of stay also decreased from 6.7 to 5.9days (P<.001). Reductions in mortality and length of stay were seen despite an increase in the number of comorbidities (P<.001). Multivariate analysis revealed that the strongest predictors of in-hospital mortality were respiratory, cardiovascular, and hepatic failures, and neurologic events. The predictors of transfer to an outpatient facility were a major operative procedure, neurologic event, respiratory failure, and weight loss. Weight loss was also an independent predictor of in-hospital mortality.
  
  
  
  Certain comorbidities and organ failures were associated with death and discharge to a skilled outpatient facility.
authors.affiliation: Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Elfeky
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA.
authors.forename: Pegah
authors.initials: P
authors.lastname: Golabi
authors.affiliation: Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA.
authors.forename: Munkhzul
authors.initials: M
authors.lastname: Otgonsuren
authors.affiliation: Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA.
authors.forename: Svetolik
authors.initials: S
authors.lastname: Djurkovic
authors.affiliation: Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Schmidt
authors.affiliation: Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA. Electronic address: Zobair.younossi@inova.org.
authors.forename: Zobair M
authors.initials: ZM
authors.lastname: Younossi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology
keywords: Disposition; Insurance; Mortality; Sepsis