Evaluating the Impact of Severe Sepsis and Septic Shock Management Bundle Compliance on In-Hospital Mortality among Patients with Severe Sepsis: A Propensity Adjusted, Nested Case-Control Study

Document Type

Conference Proceeding

Publication Date

10-19-2021

Publication Title

J Am Coll Clin Pharm

Abstract

Introduction: The Centers for Medicare and Medicaid (CMS) SEP-1 Bundle (SEP-1) is a quality metric for sepsis management and assesses antibiotic administration, lactate measurement, and blood culture collection within 3 hours of severe sepsis onset. Research has not established a mortality benefit in severe sepsis. It is imperative to examine the impact of SEP-1 in severe sepsis and evaluate how to optimize sepsis care. Research Question or Hypothesis: It is unknown whether patients with severe sepsis derive a mortality benefit from SEP-1. This investigation aims to describe the impact of SEP-1 on mortality in severe sepsis. Study Design: Retrospective, propensity adjusted, nested case-control study. Methods: Patients admitted to a large academic medical center with an initial episode of severe sepsis from 7/1/2017-12/31/2019 were included. Cases were defined as those suffering 28-day in-hospital mortality and controls as those surviving at or discharged by 28 days. The analyzable cohort was nested in a larger cohort that provided crude outcome estimates. Severe sepsis time zero was manually validated. Patients with septic shock, requiring vasopressors within eight hours of onset, or those not analyzable by SEP-1 were excluded. The primary endpoint was the propensity adjusted odds of 28-day in-hospital mortality among patients compliant versus noncompliant with SEP-1. The secondary endpoint was propensity adjusted odds of 28-day in-hospital mortality specifically assessing antibiotic compliance. SPSS statistics 25 was used for analysis. Results: 325 SEP-1 compliant and 325 SEP-1 noncompliant patients were included and analyzed. The median age was 63 and 62 years and median SOFA scores 3 and 2 between groups, respectively. There was no significant difference in 28-day in-hospital mortality among those compliant versus noncompliant with SEP-1 (Odds Ratio 1.039 [0.721-1.497]). Isolating analysis to SEP-1 antibiotic compliance revealed no difference. Conclusion: Patients with severe sepsis may not benefit from SEP-1. Further investigations are warranted to describe the impact of SEP-1 in severe sepsis.

Volume

4

Issue

12

First Page

1656

Last Page

1656

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