Comparison of patients with community-acquired and hospital-acquired sepsis or septic shock: a systematic review and meta-analysis

Abstract

Abstract Background Mortality and other clinical outcomes between community-acquired and hospital-acquired patients with sepsis or septic shock have been documented inconsistently and are controversial. A systematic review and meta-analysis was performed to compare the clinical outcomes of community-acquired and hospital-acquired sepsis or septic shock. Methods We searched the PubMed, Embase databases and Cochrane Library for studies from inception to the 1st of Oct. 2022. We included studies involving patients with sepsis or septic shock. All authors reported our primary outcome of all-cause mortality and clearly comparing community-acquired versus hospital-acquired patients with clinically relevant secondary outcomes (ICU length of stay, hospital length of stay, mechanical ventilation requirements, renal replacement requirements, days on vasopressor and cost of hospitalization). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI). Results Thirteen studies including 1175830 patients were included. The primary outcome of this meta-analysis showed that the all-cause mortality of hospital-acquired group was higher than that of the community-acquired group(OR = 0.43; 95% CI, 0.42 to 0.43; P < 0.00001; Chi2 = 262.95; I2 = 95%). Secondary outcomes demonstrated that the ICU length of stay of hospital-acquired group was longer than that of the community-acquired group(MD=-4.38;95% CI, -4.43 to -4.32; P < 0.00001;Chi2 = 2678.16; I2 = 100%), the hospital length of stay of hospital-acquired group was longer than that of the community-acquired group (MD=-12.36;95% CI, -12.44 to -12.27; P < 0.00001;Chi2 = 539.65; I2 = 98%), the mechanical ventilation requirements of hospital-acquired group was more than that of the community-acquired group (OR = 0.39; 95% CI, 0.32 to 0.46; P < 0.00001; Chi2 = 18.54; I2 = 84%), the days on vasopressor of hospital-acquired group was longer than that of the community-acquired group (MD=-1.71;95% CI, -1.78 to -164; P < 0.00001;Chi2 = 289.53; I2 = 100%), the cost of hospitalization of hospital-acquired group was more than that of the community-acquired group (MD=-34064.29; 95% CI, -34327.71 to -33800.87; P < 0.00001;Chi2 = 63.96; I2 = 98%). There was no statistically significant difference in the renal replacement requirements between two groups(OR = 0.75; 95% CI, 0.52 to 1.09; P = 0.13; Chi2 = 0.29; I2 = 0%). Conclusions The proportion of hospital-acquired sepsis or septic shock is about 12.9%. Compared with community-acquired sepsis or septic shock patients, hospital-acquired ones had higher mortality and other worse clinical outcomes, including longer ICU and hospital length of stay, more requirements of mechanical ventilation and renal replacement, longer vasopressor days and more cost of hospitalization.