Management of sepsis prescribed by the state reduces mortality

Jeremy Mr. Kahn

State-mandated care in New York was badociated with a greater decline in mortality among hospitalized adults with sepsis compared to states that do not have similar protocols, according to findings from a retrospective cohort study published in JAMA.

"Sepsis is a public health crisis that affects millions of patients every year," Jeremy Mr. Kahn, MD, MS, professor of critical care medicine and health policy management and Vice President of Academic Affairs of the Department of Critical Medicine at the University of Pittsburgh, said News on infectious diseases. "Early recognition and treatment saves lives, but unfortunately, many patients do not receive quality care. Although the use of evidence-based practices is controversial, we show that at least in this case, it seems to have worked. "

In 2013, the State of New York asked all acute care hospitals to adopt evidence-based protocols for the recognition and treatment of sepsis. Previous research has shown that prompt management and delivery of antibiotics in accordance with the mandate – called Rory's Regulations – resulted in a reduction in mortality risk.

For their study, Kahn and his colleagues included 1,012,410 sepsis admissions between January 2011 and March 2013, using the hospital's exit data while paying 509 hospitals in New York and four states of control – Florida, Maryland, Mbadachusetts and New Jersey. The main result was the mortality at the hospital within 30 days, they wrote.

Prior to the adoption of the regulation in 2013, the unadjusted 30-day hospital mortality rate in patients with sepsis in New York was 26.3%, compared to 22% in the control states said Kahn and his colleagues. In accordance with regulations, the sepsis mortality rate in New York decreased from 4.3% to 22%. In the control states, the rate decreased from 2.9% to 19.1%.

According to the researchers, New York State adjusted absolute mortality was 3.2% lower (95% CI, 1% to 5.4%) in the 10th quarter after regulation compared to Control States (P = 0.004).

The regulation was also badociated with a significant relative decrease in length of hospital stay (P = 0.04) and Clostridioides difficult infection rate (P <0.001), as well as a significant relative increase in the use of the central venous catheter (P = 0.02). They were not badociated with any significant difference in ICU admission (P = 0.09), according to the study.

Kahn said the data strongly suggests that regulation effectively reduces sepsis mortality rates.

"At present, approximately 12 states are actively considering these regulations and many more are considering them," said Kahn. "Our data clearly shows that these regulations work in New York and are likely to work elsewhere. However, since New York is unique in many respects, states should consider looking at their own sepsis consequences before fully adopting sepsis mandates. "

If the results of sepsis are already favorable because of quality improvement efforts at the regional level or other initiatives, "they may not feel as powerful as New York," he said. said Kahn. – by Joe Gramigna

Disclosures: Kahn does not report any relevant financial information. Please consult the study for the relevant financial information of all other authors.