Association between hypertension and sepsis-related complications: a retrospective nationwide inpatient sample database cross-sectional study

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BACKGROUND: Sepsis remains a significant global health challenge, with high morbidity and mortality rates. The interplay between hypertension, a prevalent comorbidity, and sepsis outcomes has been the subject of ongoing debate. This study aimed to investigate the incidence of sepsis-related complications in individuals with and without hypertension via a large nationwide inpatient database. METHODS: A retrospective observational analysis was conducted via the National Inpatient Sample (NIS) database from 2010 to 2019. The study population comprised adults (≥ 18 years) diagnosed with sepsis and stratified into hypertension and non-hypertension groups. The outcomes assessed included sepsis-related complications, in-hospital mortality, length of stay (LOS), and total hospitalization costs. RESULTS: The prevalence of hypertension among sepsis patients increased significantly from 53.17% in 2010 to 64.62% in 2019. Patients in the hypertension group were older, with a greater proportion of individuals aged 75 years and above, and presented a greater burden of comorbidities. Interestingly, the hypertension group had lower incidences of septic shock, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), and deep vein thrombosis (DVT), indicating a potential inverse association. However, they experienced higher rates of heart failure, acute kidney injury(AKI), arrhythmias, and acute respiratory failure. Despite these increased risks, the hypertension group had a shorter median LOS and lower median total hospital charges. Notably, the in-hospital mortality rate was lower in the hypertension group (11.93%) than in the nonhypertension group (13.33%). CONCLUSION: This large-scale analysis revealed a complex interplay between hypertension and sepsis outcomes. The observed lower incidence of certain severe sepsis complications among hypertensive patients suggests a potential association that might be partially related to the use of antihypertensive therapies, but this hypothesis requires further investigation into the underlying mechanisms. Our findings should be interpreted as associational, not causal. CLINICAL TRIAL NUMBER: Not applicable.

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