Thirty-Day In-Hospital Mortality and Associated Factors among Patients with Hospital-Onset Versus Community-Onset Sepsis after Intensive Care Unit Admission : A Secondary Analysis

Purpose : This study aimed to compare 30-day in-hospital mortality and identify risk factors among patients with hospital-onset and community-onset sepsis who remained hospitalized for at least 7 days following 48 hours of initial intensive care unit treatment.Methods : A secondary analysis was conducted using data from the previous study, “Nutritional risk and 30-day in-hospital mortality in adults with sepsis and septic shock: a retrospective cohort study.” A total of 346 participants were included in the analysis. Cox regression analysis (with a day-7 landmark) was performed using IBM SPSS Statistics version 26.0 and R version 4.4.1.Results : Of the 346 patients, 71 (20.5%) had hospital-onset sepsis and 275 (79.5%) had community-onset sepsis. The 30-day in-hospital mortality rates were 57.7% and 23.3%, respectively (p ＜.001). Multivariable Cox regression analysis revealed that, among patients with hospital-onset sepsis, thrombocytopenia (hazard ratio [HR]=14.66, p = .003), acute kidney injury (HR=4.73, p ＜.001), and comorbid liver cirrhosis (HR=4.99, p =.004) were independently associated with 30-day in-hospital mortality. Among patients with community-onset sepsis, acute kidney injury (HR=2.93, p =.005), hyperlactatemia on day 7 (HR=2.63, p ＜.001), and vasopressor use on day 7 (HR=2.04, p =.018) were independently associated with 30-day in-hospital mortality.Conclusion : Factors associated with 30-day in-hospital mortality differed between patients with hospital-onset and community-onset sepsis. These findings suggest that nurses should monitor distinct prognostic indicators according to sepsis onset type.