Patients with sepsis predisposed to stroke, MI in month after discharge

Patients with sepsis are at a greater risk for heart attack and stroke in the four weeks following hospital discharge, research out of Taiwan has found, with more than half of all adverse CVD events in the ensuing six months occurring within 35 days of leaving the hospital. 

The work, led by Chih-Cheng Lai and colleagues on behalf of the National Taiwan University Hospital Health Data Science Research Group, analyzed data from more than a million Taiwanese residents, 42,316 of whom presented to the hospital with sepsis. That’s not surprising, the authors said, given the prevalence of the condition in developed countries.

“In 2011, sepsis was the twelfth leading cause of death in Canada, and responsible for 1 in 18 deaths,” Lai et al. wrote in the Canadian Medical Association Journal. “In addition to the number of patient deaths attributable to sepsis, recent evidence has shown that there is an increased risk of cardiovascular complications in patients who are recovering."

Lai and co-authors said the hiked CVD risk could have something to do with endothelial dysfunction, intravascular coagulation, myocardial depression or platelet activation, but there’s little research surrounding cardiovascular risk during the recovery process for patients with sepsis.

In their analysis, the researchers found that within six months of discharge, 1,012 sepsis patients experienced a cardiovascular event. Nearly 200 suffered a myocardial infarction, while 831 patients reported they’d had a stroke. Risk was highest in the first week after discharge, and 51 percent of all heart attack or stroke events took place within 35 days.

Younger patients—those between 20 and 45 years old—were also more prone to sepsis, the authors said, while risk of heart attack and stroke was lower in those over 75.

“The observed interaction in the relative risk of MI and stroke between patients in different age categories is consistent with another Taiwanese study, in which the relative risk of MI and stroke in patients with sepsis was more evident among patients in the younger age group,” Lai et al. wrote. “Because the baseline incidence of MI and stroke in young people was low, even a small increase in the number of patients with cardiovascular complications after sepsis can translate into a high hazard ratio.”

In the hospital, patients with sepsis were more likely to be admitted to the ICU and have at least one organ dysfunction. More than a fifth died within 30 days of admission.

The authors said based on the results of this work and other related studies, the findings are likely generalizable to different populations.