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

• Published in: Clinical infectious diseases 2023-08
• Main Authors: Ling, Lowell, Zhang, Jack Zhenhe, Chang, Lok Ching, Chiu, Lok Ching Sandra, Ho, Samantha, Ng, Pauline Yeung, Dharmangadan, Manimala, Lau, Chi Ho, Ling, Steven, Man, Man Yee, Fong, Ka Man, Liong, Ting, Yeung, Alwin Wai Tak, Au, Gary Ka Fai, Chan, Jacky Ka Hing, Tang, Michele, Liu, Ying Zhi, Wu, William Ka Kei, Wong, Wai Tat, Wu, Peng, Cowling, Benjamin J, Lee, Anna, Rhee, Chanu
• Format: Article
• Language: English
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciad491

BACKGROUNDSepsis 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. METHODSThis 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. RESULTSAmong 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). CONCLUSIONSAn 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.