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

Lowell Ling; Jack Zhenhe Zhang; Lok Ching Chang; Lok Ching Sandra Chiu; Samantha Ho; Pauline Yeung Ng; Manimala Dharmangadan; Chi Ho Lau; Steven Ling; Man Yee Man; Ka Man Fong; Ting Liong; Alwin Wai Tak Yeung; Gary Ka Fai Au; Jacky Ka Hing Chan; Michele Tang; Ying Zhi Liu; William Ka Kei Wu; Wai Tat Wong; Peng Wu; Benjamin J Cowling; Anna Lee; Chanu Rhee

doi:10.1093/cid/ciad491

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

Clin Infect Dis. 2023 Aug 19:ciad491. doi: 10.1093/cid/ciad491. Online ahead of print.

Authors

Lowell Ling¹, Jack Zhenhe Zhang¹, Lok Ching Chang¹, Lok Ching Sandra Chiu¹, Samantha Ho¹, Pauline Yeung Ng^{2

3}, Manimala Dharmangadan⁴, Chi Ho Lau⁵, Steven Ling⁶, Man Yee Man⁷, Ka Man Fong⁸, Ting Liong⁹, Alwin Wai Tak Yeung¹⁰, Gary Ka Fai Au¹¹, Jacky Ka Hing Chan¹², Michele Tang¹³, Ying Zhi Liu¹, William Ka Kei Wu^{1

14

15

16

17}, Wai Tat Wong¹, Peng Wu^{18

19}, Benjamin J Cowling^{18

19}, Anna Lee¹, Chanu Rhee^{20

21}

Affiliations

¹ Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
² Critical Care Medicine Unit, The University of Hong Kong, Hong Kong SAR, China.
³ Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China.
⁴ Department of Intensive Care, Princess Margaret Hospital, Hong Kong SAR, China.
⁵ Department of Intensive Care, North District Hospital, Hong Kong SAR, China.
⁶ Department of Intensive Care, Tuen Mun Hospital, Hong Kong SAR, China.
⁷ Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
⁸ Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong SAR, China.
⁹ Department of Intensive Care, United Christian Hospital, Hong Kong SAR, China.
¹⁰ Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong SAR, China.
¹¹ Department of Intensive Care, Kwong Wah Hospital, Hong Kong SAR, China.
¹² Department of Medicine, Tseung Kwan O Hospital, Hong Kong SAR, China.
¹³ Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China.
¹⁴ State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
¹⁵ Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
¹⁶ CUHK Shenzhen Research Institute, Shenzhen, China.
¹⁷ Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong SAR, China.
¹⁸ WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
¹⁹ Laboratory of Data Discovery for Health Limited, Hong Kong Science and Technology Park, New Territories, Hong Kong SAR, China.
²⁰ Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA.
²¹ Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.

PMID: 37596856
DOI: 10.1093/cid/ciad491

Abstract

Background: Sepsis 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.

Methods: This 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.

Results: Among 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).

Conclusions: An 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.

Keywords: Sepsis-3; clinical coding; epidemiology; infections; multiple organ failure; surveillance; urban population.