Hospital Volume Affects In-Hospital Deaths From Immunosuppression, Sepsis

Immunosuppressed patients with sepsis have a higher risk for in-hospital death if they receive treatment at hospitals with a low volume of immunosuppressed patients, according to results of a new study.1

“While there is a lot of focus on improving sepsis outcomes through early interventions, some patients have poor outcomes from sepsis because their chronic medical conditions may worsen after the initial infectious insult,” said Dr Jared A. Greenberg, an assistant professor and critical care physician at Rush University Medical Center in Chicago, Illinois.2

“We hypothesized that septic patients who are immunocompromised may have improved outcomes if they are managed at hospitals that have the most experience managing immunocompromising conditions.”2


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For their study, Dr Greenberg and colleagues analyzed data collected from the Vizient database, which included 350,183 patients hospitalized with sepsis at 60 hospitals from 2010 to 2012. Patients were characterized as immunosuppressed or not immunosuppressed based on diagnosis codes and medication use.

Hospitals were grouped into quartiles based on their average volumes of immunosuppressed patients with sepsis per year.

In the 15 hospitals in the first quartile, immunosuppressed patients had an increased risk for in-hospital death than non-immunosuppressed patients at these hospitals.

The risk was similar between immunosuppressed and non-immunosuppressed patients with sepsis at hospitals in the second, third, and fourth quartiles.

Results from an additional analysis showed that the adjusted odds of death from sepsis due to a suppressed immune system of 1.21 was significantly lower in the 45 hospitals in the second, third, and fourth quartiles than in the 15 hospitals in the first quartile.

“The risk of death from sepsis due to a suppressed immune state was greatest at hospitals with the lowest volume of immunosuppressed patients with sepsis,” Dr Greenberg and colleagues concluded. “Further study is needed to determine whether this finding is related to differences in patient characteristics or care delivery at hospitals with varying exposure to immunosuppressed patients.”1

—Amanda Balbi


  1. Greenberg JA, Hohmann SF, James BD, et al. Hospital volume of immunosuppressed sepsis patients and sepsis mortality [published online June 1, 2018]. Ann Am Thorac Soc. Accessed May 30, 2018.
  2. Immunocompromised patients with sepsis may face higher mortality at hospitals treating small numbers of such patients [press release]. American Thoracic Society; June 1, 2018. URL Accessed May 30, 2018.



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