Sepsis-Attributable Mortality Lower Among SOT Recipients

Sepsis-attributable mortality was found to be lower among patients with vs without solid organ transplants (SOTs). These study results were published in Open Forum Infectious Diseases.

In this retrospective study, researchers analyzed electronic health records obtained from the Weill Cornell-Critical Care Database for Advanced Research (WC-CEDAR). They assessed whether SOT status modifies the risk of in-hospital mortality due to sepsis. Eligible patients were divided into 4 cohorts, including SOT recipients with (n=439) and without (n=281) and non-SOT recipients with (n=6793) and without (n=20,913) sepsis. The primary outcome was mortality within 28 days of intensive care unit (ICU) admission. Differences between the cohorts were analyzed via Kruskall-Wallis, analysis of variance, and chi-square testing.

Among patients included in the 4 cohorts, the median age ranged between 62 and 73 years, 35% to 46% were women, and 11% to 18% were Black. Kidney (63.8%) and liver (21.9%) were the most common types of transplants among SOT recipients. Significant differences between the cohorts included lower rates of septic shock among SOT recipients vs non-SOT recipients (P <.001), and more total comorbidities among both SOT recipients and non-SOT recipients with sepsis compared with non-SOT recipients without sepsis (P <.001).

The source of infection significantly differed between sepsis-positive cohorts (P <.001), with bacteremia, pneumonia, and urinary tract infections as the most common sources. Further analysis among the sepsis-positive cohorts showed that cytomegalovirus in the blood (1.8% vs 0.6%; P <.05), respiratory Pneumonocystic jirovecii (0.9% vs 0.3%; P <.05), and group B Streptococcus agalactiae (0.7% vs 0.1%; P <.05) were more likely to be identified among those with vs without SOTs.

In adjusted analyses, sepsis was associated with a 4.1% (95% CI, 3.8%-4.5%; P <.001) increase in the risk of 28-day mortality among non-SOT recipients. Of non-SOT recipients with and without sepsis, the adjusted rate of 28-day mortality was 22.6% (95% CI, 22.4%-22.8%) and 18.5% (95% CI, 18.2%-18.8%), respectively. For SOT recipients, sepsis was found to decrease the risk of 28-day mortality by 14.4% (95% CI, -16.8% to -12%; P <.001).

Comparisons between SOT recipients and non-SOT recipients showed that prior SOT decreased the risk of sepsis-attributable 28-mortality by 18.5% (95% CI, -21.1 to -15.9; P <.001).

Of note, septic shock was found to increase the risk of 28-day mortality among non-SOT recipients but not SOT recipients.

Limitations of this study include the single-center design the exclusion patients who met sepsis criteria more than 24 hours after ICU admission. In addition, the lower number of patients with heart and lung transplants in the population may limit the generalizability of these findings.

“[W]e found the sepsis-attributable effect on 28-day mortality to be lower in patients with SOT compared to those without SOT admitted to an ICU,” the researchers noted. “Further research is needed to elucidate the mechanisms of this observation,” they concluded.