SBUMC Professor and Colleagues Report Findings of Large-Scale Patient Study in JAMA
STONY BROOK, N.Y., October 27, 2010 — A study of nearly 1,200 older patients hospitalized for severe sepsis indicate that those who survive are at higher risk for long-term cognitive impairment and physical limitations than those hospitalized for other reasons. This conclusion was reached by a group of investigators nationwide, including Dylan M. Smith, Ph.D., Associate Professor, Center for Medical Humanities, Compassionate Care, and Bioethics, in the Department of Preventive Medicine at Stony Brook University Medical Center. The study is reported in the October 27 issue of the Journal of the American Medical Association.
Sepsis is a condition in which the immune system goes into overdrive releasing chemicals into the blood to combat infection. Sepsis occurs in 1 percent to 2 percent of all hospitalizations in the United States. Sepsis often results after common problems such as pneumonia and urinary tract infections. Approximately 40 percent of those with severe sepsis die from the condition.
“In this patient population, we found that the odds of acquiring moderate to severe cognitive impairment were 3.3 times higher following an episode of sepsis than for other hospitalizations,” says Dr. Smith, who helped design the statistical analysis of the study.
Overall, the study also showed that 60 percent of hospitalizations for severe sepsis were associated with worsened cognitive and physical function among surviving older adults. Severe sepsis also was associated with greater risk for the development of new functional limitations following hospitalization.
Among patients who had no limitations before sepsis, more than 40 percent developed trouble with walking. Nearly 1 in 5 developed new problems with shopping or preparing a meal. Patients often developed new problems with such basic things as bathing and toileting themselves.
“We used to think of sepsis as just a medical emergency, an infection that you get sick with and then recover,” says lead author, Theodore (Jack) Iwashyna, M.D., Ph.D., Assistant Professor of Internal Medicine at the University of Michigan Health System. “But we discovered a significant number of people face years of problems afterwards.
“These new data show a majority of older patients suffer with real life-changing burdens after beating sepsis. This is an under recognized public health problem with major implications for patients, families and the health care system,” Dr. Iwashyna adds.
Patients in the study had a mean age of nearly 76.9 years. The cohort involved 1,194 patients with 1,520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of U.S. residents from 1998 to 2006, which collects information on the health, economic, and social factors influencing the health and well-being of Americans over age 50.
From this grouping, a total of 9,223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4,517 survived a nonsepsis hospitalization.
The research was supported primarily by the National Institute on Aging and the National Heart, Lung and Blood Institute.
In addition to Drs. Iwashyna and Smith, co-authors include: E. Wesley Ely, M.D., M.P.H., of Vanderbilt University, and Kenneth M. Langa, M.D., Ph.D., University of Michigan Medical School.