It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Thursday, February 02, 2023
Smart stitches could reduce infection and simplify post op monitoring
A new antimicrobial suture material that glows in medical imaging could provide a promising alternative for mesh implants and internal stitches.
IMAGE: PROFESSOR ELISA HILL-YARDIN, DR SHADI HOUSHYAR AND PROFESSOR JUSTIN YEUNG INSPECT A PROTOTYPE OF THE IODINE-INFUSED FILAMENT.view more
CREDIT: RMIT UNIVERSITY.
A new antimicrobial suture material that glows in medical imaging could provide a promising alternative for mesh implants and internal stitches.
Surgical site infections are one of the most common medical infections, occurring in 2 to 4% of patients post-surgery. For some procedures, such as vaginal mesh implants to treat prolapse, infection rates can be higher.
Study lead author and Vice Chancellor’s Senior Research Fellow, Dr Shadi Houshyar, said their suture was being developed in partnership with clinicians specifically for this type of procedure.
“Our smart surgical sutures can play an important role in preventing infection and monitoring patient recovery and the proof-of-concept material we’ve developed has several important properties that make it an exciting candidate for this,” said Houshyar, from the School of Engineering at RMIT University, Australia.
Lab tests on the surgical filament, published in OpenNano, showed it was easily visible in CT scans when threaded through samples of chicken meat, even after three weeks. It also showed strong antimicrobial properties, killing 99% of highly drug-resistant bacteria after six hours at body temperature.
Houshyar said the team was not aware of any commercially available suture products that combined these properties.
How they did it
The multidisciplinary team led by RMIT – included nano-engineering, biomedical and textile experts working in partnership with a practicing surgeon – used the university’s cutting-edge textile manufacturing facility to develop their proof-of-concept material.
The suture’s properties come from the combination of iodine and tiny nanoparticles, called carbon dots, throughout the material.
Carbon dots are inherently fluorescent, due to their particular wavelength, but they can also be tuned to various levels of luminosity that easily stand out from surrounding tissue in medical imaging.
Attaching iodine to these carbon dots, meanwhile, provides them with their strong antimicrobial properties and greater X-ray visibility.
Houshyar said carbon nano dots were safe, cheap and easy to produce in the lab from natural ingredients.
“They can be tailored to create biodegradable stitches or a permanent suture, or even to be adhesive on one side only, where required,” she said.
“This project opens up a lot of practical solutions for surgeons, which has been our aim from the start and the reason we have involved clinicians in the study.”
Clinical possibilities
Consultant colorectal surgeon and Professor of Surgery at the University of Melbourne, Justin Yeung, was involved in the study. He said it addressed a real challengefaced by surgeons in trying to identify the precise anatomical location of internal meshes on CT scans.
"This mesh will enable us to help with improved identification of the causes of symptoms, reduce the incidence of mesh infections and will help with precise preoperative planning, if there is a need to surgically remove this mesh,” he said.
“It has the potential to improve surgery outcomes and improve quality of life for a huge proportion of women, if used as vaginal mesh for example, by reducing the need for infected mesh removal.”
“It may also significantly reduce surgery duration and increase surgical accuracy in general through the ability to visualise mesh location accurately on preoperative imaging.”
Next steps
Study co-author from RMIT’s School of Health and Biomedical Sciences, Professor Elisa Hill-Yardin, said the next steps were pre-clinical trials.
“While this research is at an early stage, we believe we are onto something very promising that could help a lot of people and are really keen to speak with industry partners who are interested in working with us to take it further,” she said.
“We see potential especially in vaginal mesh implants and similar procedures.”
The research team used Australia’s leading university-based textile manufacturing facilities at RMIT’s Centre for Materials Innovation and Future Fashion to produce the proof-of-concept material. They will soon be producing larger suture samples to use in pre-clinical trials, which they have just received seed funding for from RMIT.
IMAGE: THE FIGURE SHOWS HOW NEW INFORMATION IS LEARNED EACH TIME A DATA DISTRIBUTION IS INPUT, WHILE RETAINING INFORMATION LEARNED IN THE PAST.view more
CREDIT: NAOKI MASUYAMA, OSAKA METROPOLITAN UNIVERSITY
Advances in IoT technology have made it possible for us to easily and continually obtain large amounts of diverse data. Artificial intelligence technology is gaining attention as a tool to put this big data to use.
Conventional machine learning mainly deals with single-label classification problems, in which data and corresponding phenomena or objects (label information) are in a one-to-one relationship. However, in the real world, data and label information rarely have a one-to-one relationship. In recent years, therefore, attention has focused on the multi-label classification problem, which deals with data that has a one-to-many relationship between data and label information. For example, a single landscape photo may include multiple labels for elements such as sky, mountains, and clouds. In addition, to efficiently learn from big data that is obtained continually, the ability to learn over time without destroying things that were learned previously is also required.
A research group led by Associate Professor Naoki Masuyama and Professor Yusuke Nojima of the Osaka Metropolitan University Graduate School of Informatics, has developed a new method that combines classification performance for data with multiple labels, with the ability to continually learn with data. Numerical experiments on real-world multi-label datasets showed that the proposed method outperforms conventional methods.
The simplicity of this new algorithm makes it easy to devise an evolved version which can be integrated with other algorithms. Since the underlying clustering method groups data based on the similarity between data entries, it is expected to be a useful tool for continual big data preprocessing. In addition, the label information assigned to each cluster is learned continually, using a method based on Bayesian approach. By learning the data and learning the label information corresponding to the data separately and continually, so that both high classification performance and continual learning capability are achieved.
“We believe that our method is capable of continual learning from multi-label data and has capabilities required for artificial intelligence in a future big data society,” Professor Masuyama concluded.
Osaka Metropolitan University is a new public university established by a merger between Osaka City University and Osaka Prefecture University in April 2022. For more science news, see https://www.omu.ac.jp/en/, and follow @OsakaMetUniv_en, or search #OMUScience.
JOURNAL
IEEE Transactions on Pattern Analysis and Machine Intelligence
Belmont, MA – Black children in the United States are more likely to experience childhood adversity than White children, and these disparities are reflected in differential changes to regions of the brain linked to psychiatric disease like posttraumatic stress disorder (PTSD), according to new research led by McLean Hospital, a member of Mass General Brigham.
The findings, published February 1 in the American Journal of Psychiatry, the flagship journal of the American Psychiatric Association, suggest that adversity may act as a toxic stressor to regions of the brain related to threat processing and that this exposure is disproportionately seen in Black children. The authors added that their study provides additional evidence contradicting the pseudoscientific falsehood that there are inherent race-related differences found in the brain and instead emphasizes the role of adversity brought on by structural racism.
For the study, led by Nathaniel Harnett, PhD, director of the Neurobiology of Affective Traumatic Experiences Laboratory at McLean Hospital, researchers analyzed surveys and MRI brain scans of more than 7,300 White children and nearly 1,800 Black children in the U.S. who were 9 and 10 years old. They found Black children displayed small neurobiological differences reflected as lower gray matter volumes in the amygdala, hippocampus and prefrontal cortex compared with White children. Their analysis also revealed that experiencing adversity was the significant differentiating factor, with household income the most common predictor of brain volume differences.
“Our research provides substantial evidence of the effects structural racism can have on a child’s developing brain, and these small differences may be meaningful for their mental health and wellbeing through adulthood,” said Dr. Harnett, who is also an Assistant Professor of Psychiatry at Harvard Medical School. “The dataset in our study included children younger than 10 years old – children who have no choice in where they are born, who their parents are and how much adversity they are exposed to. These findings offer another chilling reminder of the public health impact of structural racism, and how crucial it is to address these disparities in a meaningful way.”
Mining data for social determinants of adversity and impact on brain
In the US., there are stark racial disparities in the distribution of economic resources, exposure to stress, and psychiatric disorder prevalence. To date, limited research has investigated how racial inequities in the social determinants of health may lead to changes in the brain for different groups.
This led Dr. Harnett and colleagues at McLean’s Neurobiology of Fear Laboratory to leverage strong datasets to look for potential race-related differences in the neurobiology of psychiatric disorders and how racial structural inequities may explain these differences.
The researchers reviewed data from the 2019 Adolescent Brain and Cognitive Development (ABCD) Study, a large-scale MRI research effort that included nearly 12,000 U.S. children between the ages of 9 and 10 from 21 sites across the country. Study participants’ parents filled out surveys assessing parent and child race and ethnicity; parental education, employment and family income; and other variables. Children also completed assessments that captured emotional and physical conflicts within their household. Also included were measures of neighborhood disadvantage using the Area Deprivation Index, which utilizes 17 socioeconomic indicators from the U.S. Census, including poverty and housing, that characterize a given neighborhood.
The analysis found that White children’s parents were three times more likely to be currently employed than Black children’s parents. White children’s parents also attained a higher level of education and had greater family income compared with Black children’s parents. Specifically, about 75 percent of White parents had a college degree, compared with nearly 41 percent of Black parents, and about 88 percent of White parents made $35,000 a year or more, compared with about 47 percent of Black parents. White children also experienced less family conflict, less material hardship, less neighborhood disadvantage and fewer traumatic events compared with Black children.
When assessing corresponding MRI data, experiencing childhood adversity was associated with lower gray matter volumes in the amygdala, hippocampus and prefrontal cortex – effects more likely to be seen in Black children. The amygdala plays an important role in the learning of a fear response, the hippocampus in memory formation, and the prefrontal cortex is what regulates the emotional and threat response to fear. The researchers observed neurobiological effects tied to most adversity indicators with income being the most frequent predictor, affecting gray matter volume in eight of 14 regions of the brain studied. Trauma history and family conflict were not related to gray matter volume in any of the models; however, the researchers note that doesn’t necessarily reflect that there is no neurobiological impact from those adversities.
Additional analysis factoring in previous studies on PTSD and regions of the brain found Black children had significantly greater PTSD symptom severity, and symptom severity was further predicted by adversity.
“I consider these findings critically important, as they speak to the need for Psychiatry as a field to be outspoken about the detrimental psychological impacts of race-related disparities in childhood adversity, to call out the fact that these disparities stem from structural racism, and to vigorously support rectifying efforts by pursuing policy changes,” said Ned H. Kalin, MD, Editor-in-Chief of the American Journal of Psychiatry.
Future study of neurobiological impact of structural racism
Future research from this team will build upon these findings and expand their data collection beyond the ages included in this study in an effort to track the neurobiological impact racial disparities in adversity have throughout a lifetime. The researchers also hope to determine whether exposure to adversity may accelerate or decelerate aging in the brain, and whether additional measures of adversity not included in this study may impact these regions of the brain or others involved in psychiatric disorders.
“These findings may just be the tip of the iceberg,” said Dr. Harnett.
About McLean: McLean Hospital has a continuous commitment to put people first in patient care, innovation and discovery, and shared knowledge related to mental health. It is consistently named the #1 freestanding psychiatric hospital in the United States by U.S. News & World Report, and is #1 in America for psychiatric care in 2022-23. McLean Hospital is the largest psychiatric affiliate of Harvard Medical School and a member of Mass General Brigham. To stay up to date on McLean, follow us on Facebook, YouTube, and LinkedIn.
American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 37,000 physician members specializing in the diagnosis, treatment, prevention, and research of mental illnesses. APA's vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.
Racial Disparities in Adversity During Childhood and the False Appearance of Race-Related Differences in Brain Structure
ARTICLE PUBLICATION DATE
1-Feb-2023
COI STATEMENT
Dr. Lebois has served as an unpaid member of the Scientific Committee for the International Society for the Study of Trauma and Dissociation, and her spouse receives payments from Vanderbilt University for technology licensed to Acadia Pharmaceuticals. Dr. Ressler has served on advisory boards or as a consultant for Acer, Bionomics, BioXcel, the Brain Research Foundation, Janssen, Jazz Pharmaceuticals, Sage, Takeda, and Verily, and he has received sponsored research support from Alkermes, Alto Neuroscience, BrainsWay, Genomind, and Takeda. The other authors report no financial relationships with commercial interests.
Inequities in cancer treatment delay or discontinuation following SARS-CoV-2 infection
About The Study: The findings of this study of 4,768 patients with cancer suggest that race and ethnicity and area-level social determinants of health were associated with delayed or discontinued cancer treatment and longer delays to the restart of drug-based therapies following SARS-CoV-2 infection. Such treatment delays could exacerbate persistent cancer survival inequities in the United States.
Authors: Adana A. M. Llanos, Ph.D., M.P.H., of the Columbia University Irving Medical Center in New York, is the corresponding author.
About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.
JOURNAL
JAMA Network Open
A strong ethnic identity can buffer or bolster the effects of online sexual racism in Black men
UNIVERSITY OF ILLINOIS AT URBANA-CHAMPAIGN, NEWS BUREAU
IMAGE: : A STRONG COMMITMENT TO THEIR ETHNIC IDENTITY MAY BE A DOUBLE-EDGED SWORD FOR YOUNG SEXUAL MINORITY BLACK MEN, BUFFERING THEM FROM THE NEGATIVE MENTAL HEALTH EFFECTS OF DISCRIMINATION IN SOME CIRCUMSTANCES WHILE INTENSIFYING THESE EFFECTS IN OTHERS, SOCIAL WORK PROFESSOR RYAN WADE FOUND IN A RECENT STUDY.view more
CREDIT: PHOTO BY L. BRIAN STAUFFER
CHAMPAIGN, Ill. — While some scholars believe that a strong ethnic identity mitigates the negative mental health impact of racism for people of color, others suggest it can exacerbate these effects.
A recent study of sexual racism experienced by young sexual minority Black men in online dating communities sheds light on these differing outcomes and the circumstances in which they can occur.
In a sample of almost 700 of these men, researchers at the University of Illinois Urbana-Champaign found that having a strong or moderate commitment to their ethnic identity – defined as finding solidarity and a sense of belonging in their heritage – had protective effects, buffering feelings of depression and lower self-worth when they experienced sexual objectification by white men online, a form of racialized sexual discrimination driven by racial stereotypes such as beliefs that all Black men are physically imposing or well-endowed.
Conversely, however, a strong commitment to their ethnic identity intensified feelings of low self-worth when these men were rejected by those of their own race, the researchers found.
Published in the International Journal of Environmental Research and Public Health, the findings clarify how individuals’ emotional investment in their ethnicity can be a double-edged sword, buffering them from racism in some circumstances while exacerbating its harmful effects in others, said Ryan M. Wade, a professor of social work at the university and the first author of the study.
The men in the study were recruited primarily through ads on Facebook and Scruff, a mobile app used by gay and bisexual men to meet partners for dating or sex. Study participants’ average age was about 24, and the majority were gay (71%) or bisexual (16%).
“Same-race discrimination may be particularly bewildering and painful for young sexual minority Black men, who tend to identify strongly with their racial or ethnic heritage and value being accepted by others in their ethnic group,” Wade said.
Co-written by graduate student Matthew M. Pear, the study is believed to be the first to explore the role of ethnic identity on racialized sexual discrimination experienced by those who seek sexual or romantic partners through dating apps and online venues, Wade said.
“The very personal and often vulnerable nature of intimate partner-seeking makes RSD in these online dating venues a unique stressor,” Wade said. “In these high-density, quasi-anonymous online settings, discrimination is typically more brazen, prejudices more overt and rejection more frequent.”
Additionally, the study shed light on another dimension of identity development – ethnic identity exploration – that is less understood. Wade said some prior researchers suggested that greater engagement in exploring one’s ethnic identity reflects uncertainty or a lack of commitment to it and may heighten individuals’ risks of discrimination and poor psychological well-being.
“Much of the research has not disaggregated these two components of ethnic identity – commitment and exploration – making it difficult to determine whether these negative mental health effects are driven by both components or one over the other,” Wade said. “We wanted to provide clarity on that.”
Among the men in the current study, only ethnic identity commitment modified the relationship between discrimination and mental health; ethnic identity exploration had no significant effect – which may indicate it has limited bearing on mental well-being for people in general or for young sexual minority Black men in particular, the researchers said.
“Having a firm commitment to ethnic identity may encourage individuals to explore their ethnic group heritage, or the process of exploration may ultimately help individuals develop a stronger sense of commitment to their heritage,” Wade and Pear wrote.
Study participants completed surveys that measured depressive symptoms and feelings of self-worth, along with self-perceived sexual attractiveness and sensitivity to perceived rejection.
Dating app usage varied widely among these men – from once a day (9%) to once a month or less (26%).
The researchers collected data on three forms of RSD – same-race rejection; beliefs that white or Eurocentric characteristics are the most desirable; and sexual objectification by white men.
The study assessed the frequency of participants’ exposure to RSD as well as their emotional reactions while browsing user profiles online – which often express preferences for potential partners of certain races – or when exchanging written communications with other users.
In general, those in the study reported moderate levels of self-worth and low-to-moderate depressive symptoms. However, all three forms of RSD were associated with poorer psychological well-being, the researchers found.
Men with high levels of ethnic identity commitment – those who felt the greatest sense of attachment to their ethnic group and took pride in it – scored lower on depressive symptoms and higher on self-worth across all the data models.
These men experienced the lowest sense of self-worth when rejected by potential partners of their own race, compared with those with moderate or low scores on ethnic identity commitment. This suggests that, for individuals with the strongest emotional ties to their ethnic group, rejection by others who share their ethnicity may be the most harmful RSD experiences, Wade said.
“When same-race rejection occurs, we should consider whether the perpetrators experience a degree of internalized racism and/or view whiteness as the hallmark of desirability,” Wade said.
“Critical consciousness programs could address RSD by analyzing popular media’s objectification of Black men or by exploring same-race discrimination as a facet of white supremacy throughout American history,” he said.
JOURNAL
International Journal of Environmental Research and Public Health
Online dating and mental health among young sexual minority Black men: Is ethnic identity protective in the face of sexual racism?
New University Hospitals Seidman Cancer Center study demonstrates the critical importance of social determinants of health when evaluating the association of race and cancer outcomes
Research published in JAMA Network Open of the Journal of American Medical Association
CLEVELAND - A new study led by Randy Vince Jr., MD, MS, and Daniel Spratt, MD, demonstrates the link between cancer outcomes and social determinants of health (SDOH), as opposed to only race.
It is commonly known that Black men have worse prostate cancer outcomes than White men. This association is often described as being driven largely by race in biomedical research, as opposed to other factors such as institutional racism and SDOH.
Drs. Vince and Spratt recently published in the Journal of Clinical Oncology that less than 5 percent of studies throughout history acknowledge that race is a social construct, nor was there any acknowledgment that this association is potentially driven by racism and SDOH. These findings led to the present study, published by JAMA Network Open on Jan. 11.
This was a meta-analysis of 47 studies of more than 1 million men with prostate cancer. Each individual study investigated the association of race with death from prostate cancer and overall survival between Black and White men. The authors developed a tool to capture the extent that SDOH were accounted for in each study.
In the studies with minimal accounting for SDOH, Black patients had significantly higher mortality than White patients. However, Black men had significantly lower mortality from prostate disease (called prostate cancer-specific mortality – PCSM) in studies with greater accounting for SDOH. This powerful result highlights the importance of how racial disparities and health outcome research are conducted, as improper methods can lead to improper conclusions that inadvertently perpetuate racialization.
“These findings coincide with the commonly said phrase, ‘racism is the risk factor, not race,’” said Dr. Vince, Assistant Professor of Urology and Director of Minority Men’s Health at University Hospitals, Case Western Reserve University School of Medicine and the lead author of the study. “I hope our results will motivate researchers and society to rethink how we analyze and attempt to address racial disparities. In order to address the current inequities at hand, we must acknowledge the past that has led us to this position. Any efforts to achieve equity that do not recognize and attempt to reverse the impact of various forms of racism will continue to be futile.”
Dr. Spratt, senior author and Vincent K. Smith Chair in Radiation Oncology and Professor in the Department of Radiation Oncology at UH Seidman Cancer Center and Case Western Reserve University, said: “The scientific and biomedical fields have inadvertently perpetuated the notion that race, rather than racism, impacts cancer outcomes. This is especially true when it comes to the inferior outcomes for Black patients with cancer. Our study not only demonstrates that most health outcomes research conducted on race and prostate cancer outcomes adjusted for few if any confounding SDOH variables, but when accounting for SDOH even partially, Black men had similar to improved cancer outcomes compared to White men. As race is a social construct, this should not be surprising. However, medical education has been shown to rarely teach, and the biomedical scientific community to rarely report that differences observed between Black and White patients are often driven by SDOH and racism, not race.”
Vince RA, Jiang R, Bank M, et al. Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis. The Journal of American Medical Association Network Open. 2023;6(1):e2250416. doi:10.1001/jamanetworkopen.2022.50416
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About University Hospitals / Cleveland, Ohio Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 21 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University and the Technion Israel Institute of Technology. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebookand Twitter. For more information, visit UHhospitals.org.
JOURNAL
JAMA
METHOD OF RESEARCH
Meta-analysis
ARTICLE TITLE
Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis
Sepsis increased risk of heart failure and rehospitalization after hospital discharge
A new study in the Journal of the American Heart Association found people hospitalized for sepsis or who developed it while hospitalized were at an elevated risk for heart failure or rehospitalization within 12 years
After hospital discharge, people hospitalized for sepsis or who developed it while hospitalized had a 38% higher risk of rehospitalization for all causes and a 43% higher risk of rehospitalization for cardiovascular causes compared to people without sepsis during hospitalization.
The risk of developing heart failure after hospital discharge was 51% higher among people who had sepsis while hospitalized compared to those who did not have sepsis while hospitalized.
People who had sepsis while hospitalized also had a 27% higher risk of death after hospital discharge compared to people without sepsis.
DALLAS, February 1, 2023 — People who are discharged after a hospitalization involving sepsis were at greater risk of cardiovascular events, rehospitalization for any cause or death during a maximum follow-up of 12 years compared to those hospitalized and did not have sepsis, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed Journal of the American Heart Association.
Sepsis is a leading cause of hospitalization and death worldwide. Each year in the U.S., about 1.7 million people develop sepsis, an extreme immune response to an infection in the bloodstream that can spread throughout the whole body and lead to organ failure and possibly death.
“We know that infection may be a potential trigger for myocardial infarction or heart attack, and infection may also predispose a patient to other cardiovascular events, either directly during infection or later when the infection and related effects on the body promote progressive cardiovascular disease,” said lead study author Jacob C. Jentzer, M.D., FAHA, an assistant professor of medicine in the department of cardiovascular medicine at the Mayo Clinic in Rochester, Minnesota. “We sought to describe the association between sepsis during hospitalization and subsequent death and rehospitalization among a large group of adults.”
In this study, researchers examined whether adults who had sepsis may have a higher risk of death and a higher risk of rehospitalization for cardiovascular events after hospital discharge. They queried a database containing administrative claims data and identified more than 2 million enrollees of commercial and Medicare Advantage insurance across the U.S. who survived a non-surgical hospitalization of two nights or more between 2009 and 2019. Of these patients, who were ages 19-87 years, the medical claims indicate more than 800,000 had sepsis during their hospital stay. The researchers analyzed the association of hospitalization with sepsis, rehospitalization and death over a follow-up period from 2009 to 2021.
Because variations in sepsis diagnosis and documentation may affect outcomes in research and clinical treatment, researchers included two standard diagnosis codes used for sepsis: explicit and implicit. Explicit sepsis means a physician formally diagnosed the patient. Implicit sepsis is an administrative code in the electronic health record given automatically when a patient has both an infection and organ failure, which is the currently accepted definition of sepsis. The presence of either definition of sepsis was used to classify patients as having sepsis versus no sepsis.
To focus on the potential cardiovascular impact of sepsis, researchers compared 808,673 hospitalized patients who had sepsis to 1,449,821 hospitalized patients who did not develop sepsis but still had cardiovascular disease or one or more cardiovascular disease risk factors (older age, hypertension, hyperlipidemia, type 2 diabetes, chronic kidney disease, obesity or smoking).
The analysis found:
Compared to patients who did not have sepsis during their hospital stay, those with sepsis were 27% more likely to die, 38% more likely to be rehospitalized for any cause and 43% more likely to return to the hospital specifically for cardiovascular causes in the 12 years after having sepsis.
Heart failure was the most common major cardiovascular event (including stroke, heart attack, arrhythmia and heart failure) among people who had sepsis. People who had sepsis while hospitalized had a 51% higher risk of developing heart failure during the follow-up period.
Patients with implicit sepsis (infection with organ failure) had a two-fold increased risk of rehospitalization for cardiovascular events compared to those with explicit sepsis (formal diagnosis by a physician).
“Our findings indicate that after hospitalization with sepsis, close follow-up care is important, and it may be valuable to implement cardiovascular prevention therapies with close supervision,” Jentzer said. “Professionals need to be aware that people who have previously had sepsis are at very high risk for cardiovascular events, and that it may be necessary to advise them to increase the intensity of their cardiovascular prevention.”
The study authors will continue to evaluate new data on people who have previously had sepsis during hospitalization in order to map out their needs for cardiovascular prevention therapies. “It’s an important opportunity to establish what might and might not work in the future for people who have had sepsis,” Jentzer said.
The main limitation of the study is that it is a retrospective cohort study that uses data gathered through hospital administration. This meant that researchers were assessing past records and did not have information on the severity of sepsis.
Co-authors are Patrick R. Lawler, M.D., M.P.H.; Holly K. Van Houten, B.A.; Xiaoxi Yao, Ph.D., M.P.H.; Kianoush B. Kashani, M.D., M.S.; and Shannon M. Dunlay, M.D., M.S. Authors’ disclosures are listed in the manuscript.
The study was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Mayo Clinic Department of Cardiovascular Medicine.
Statements and conclusions of studies published in the American Heart Association’s scientific journals are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.
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About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.
