Variable Period of Risk for Myocardial Infarction and Stroke Following Sepsis

Patients recovering from sepsis had an elevated risk for myocardial infarction (MI) or stroke in the first 4 weeks after hospital discharge compared to the general population, according to data published in the Canadian Medical Association Journal.

Using a retrospective population-based cohort study, 42,316 patients with sepsis were identified from the National Health Insurance Research Database in Taiwan. The risk for MI and stroke following sepsis was assessed by comparing data from individuals who had sepsis to individuals of a matched population and hospital control group.

Stroke and MI occurred in 831 and 184, respectively, of patients who had sepsis within 180 days of discharge. Compared to controls, patients with sepsis had the highest risk for MI or stroke in the first week (hazard ratio [HR] 4.78; 95% CI, 3.19-7.17; risk difference .0028; 95% CI, .0021-.0034). This decreased through day 28 following discharge (HR 2.38; 95% CI, 1.94-2.92; risk difference .0045; 95% CI, .0035-.0056) at which time the risk stabilized. Multiple analyses comparing data from participants with sepsis and control participants revealed an attenuated but markedly elevated risk before day 36 (HR 1.32; 95% CI, 1.15-1.52; risk difference .0026; 95% CI, .0013-.0039). 

The risk for MI and stroke was also shown to interact with age, as younger patients were associated with a higher risk than older ones (interaction P =.0004). Investigators noted a secondary finding from their research that, “in addition to having an increased risk of MI and stroke, a propensity-matched cohort study suggested that, shortly after discharge, patients who have recovered from sepsis had a higher risk of short-term mortality (< 180 d) than long-term mortality (> 180 d).”

Because MI and stroke are independent risk factors for infection, only incident MI and stroke that occurred after the patient was discharged from the hospital admission index for sepsis were investigated to minimize protopathic bias. It is possible, however, that this underestimated the risk for MI and stroke after sepsis that developed during the index hospital admission. Detailed in-hospital parameters and laboratory results were also not available because of the use of administrative databases, resulting in investigators being unable to assess classification of patients into different severity scoring systems, which affects the risk for MI and stroke. Further, lifestyle factors and stroke subtypes could not be analyzed, also because of the use of administrative databases, but alcohol, smoking, or obesity-related diseases were used as a proxy for lifestyle factors.

Researchers report a tentative recommendation of 180 days of follow-up as likely to be sufficient to identify the susceptible period for cardiovascular complications after sepsis. The results demonstrated a time-varying risk profile of MI and stroke after sepsis in a Taiwanese population, but investigators also concluded that further work in other populations is still required to fully validate the findings.

Reference

Lai CC, Lee MG, Lee WC, et al. Susceptible period for cardiovascular complications in patients recovering from sepsis. CMAJ. 2018;190:E1062-E1069