Population sepsis incidence, mortality, and trends in Hong Kong between 2009-2018 using clinical and administrative data.

View Abstract

BACKGROUND

Sepsis surveillance using electronic health record (EHR)-based data may provide more accurate epidemiologic estimates than administrative data, but experience with this approach to estimate population-level sepsis burden is lacking.

METHODS

This was a retrospective cohort study including all adults admitted to publicly-funded hospitals in Hong Kong between 2009-2018. Sepsis was defined as clinical evidence of presumed infection (clinical cultures and treatment with antibiotics) and concurrent acute organ dysfunction (≥2 point increase in baseline SOFA score). Trends in incidence, mortality, and case fatality risk (CFR) were modelled by exponential regression. Performance of the EHR-based definition was compared with 4 administrative definitions using 500 medical record reviews.

RESULTS

Among 13,550,168 hospital episodes during the study period, 485,057 (3.6%) had sepsis by EHR-based criteria with 21.5% CFR. In 2018, age- and sex-adjusted standardized sepsis incidence was 759 per 100,000 (relative +2.9%/year [95%CI 2.0, 3.8%] between 2009-2018) and standardized sepsis mortality was 156 per 100,000 (relative +1.9%/year [95%CI 0.9,2.9%]). Despite decreasing CFR (relative -0.5%/year [95%CI -1.0, -0.1%]), sepsis accounted for an increasing proportion of all deaths (relative +3.9%/year [95%CI 2.9, 4.9%]). Medical record reviews demonstrated that the EHR-based definition more accurately identified sepsis than administrative definitions (AUC 0.91 vs 0.52-0.55, p < 0.001).

CONCLUSIONS

An objective EHR-based surveillance definition demonstrated an increase in population-level standardized sepsis incidence and mortality in Hong Kong between 2009-2018 and was much more accurate than administrative definitions. These findings demonstrate the feasibility and advantages of an EHR-based approach for widescale sepsis surveillance.

Investigators
Abbreviation
Clin Infect Dis
Publication Date
2023-08-19
Pubmed ID
37596856
Medium
Print-Electronic
Full Title
Population sepsis incidence, mortality, and trends in Hong Kong between 2009-2018 using clinical and administrative data.
Authors
Ling L, Zhang JZ, Chang LC, Chiu LCS, Ho S, Ng PY, Dharmangadan M, Lau CH, Ling S, Man MY, Fong KM, Liong T, Yeung AWT, Au GKF, Chan JKH, Tang M, Liu YZ, Wu WKK, Wong WT, Wu P, Cowling BJ, Lee A, Rhee C