Description:
In-hospital mortality rate among acute care inpatient discharges meeting the proxy case definition for the Third International Consensus Definition for Sepsis (SEP-3) based on the modified Dombrovskiy Method for case identification.
Under SEP-3, sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. This third sepsis definition, also called Sepsis-3, eliminates the requirement for the presence of systemic inflammatory response syndrome (SIRS) to define sepsis, and it removed the severe sepsis definition. What was previously called severe sepsis is now the new definition of sepsis.
Note: Although the cases are identified based on meeting the proxy definition for sepsis or septic shock, these conditions are not necessarily the primary diagnoses or causes of death for the cases.
Methodology:
SEP-3 sepsis and septic shock cases are are identified through the presence of combinations of ICD-10-CM diagnosis codes on hospital acute care inpatient discharge records based on a proxy case definition created and maintained by HQI.
Inclusion/Exclusion Criteria:
- Include only inpatient discharges
- Include only acute care cases (Type of Care equal to 1)
SEP-3 Sepsis Proxy Case Definition: Cases meeting the inclusion/exclusion criteria above that have one or more primary or secondary diagnosis codes listed in the ICD-10-CM CODES TO IDENTIFY SEPTICEMIA OR SEPSIS code set and one or more primary or secondary diagnosis codes listed in the ICD-10-CM CODES TO IDENTIFY ORGAN DYSFUNCTION code set.
Download the code set used for the proxy case definition.
Denominator: Total number of acute-care inpatient discharges meeting the proxy case definition during the measurement timeframe.
Numerator: Number of acute-care inpatient discharges meeting the proxy case definition during the measurement timeframe with a discharge disposition of “Expired” (Disposition of Patient = 20).
Rate Calculation: Percentage calculated as (Numerator/Denominator) x 100.
ICD-10-CM CODES TO IDENTIFY SEPTICEMIA OR SEPSIS
| Code | Code Description |
|---|---|
| A02.1 | Salmonella sepsis |
| A20.7 | Septicemic plague |
| A21.7 | Generalized tularemia |
| A22.7 | Anthrax sepsis |
| A26.7 | Erysipelothrix sepsis |
| A32.7 | Listerial sepsis |
| A39.1 | Waterhouse-Friderichsen syndrome |
| A39.2 | Acute meningococcemia |
| A39.3 | Chronic meningococcemia |
| A39.4 | Meningococcemia, unspecified |
| A40.x | Streptococcal sepsis |
| A41.x | Other sepsis |
| A42.7 | Actinomycotic sepsis |
| A54.86 | Gonococcal sepsis |
| B00.7 | Disseminated herpesviral disease |
| B37.7 | Candidal sepsis |
| I26.01 | Septic pulmonary embolism with acute cor pulmonale |
| I26.90 | Septic pulmonary embolism without acute cor pulmonale |
| I76 | Septic arterial embolism |
| O03.37 | Sepsis following incomplete spontaneous abortion |
| O03.87 | Sepsis following complete or unsp spontaneous abortion |
| O04.87 | Sepsis following (induced) termination of pregnancy |
| O07.37 | Sepsis following failed attempted termination of pregnancy |
| O08.82 | Sepsis following ectopic and molar pregnancy |
| O85 | Puerperal sepsis |
| O86.04 | Sepsis following an obstetrical procedure |
| O86.09 | Sepsis following an obstetrical procedure other surgical site |
| O86.81 | Puerperal septic thrombophlebitis |
| O88.3x | Obstetric pyemic and septic embolism |
| P36.x | Bacterial sepsis of newborn |
| R65.2x | Severe Sepsis |
| T81.12xx | Postprocedural septic shock |
| T81.44xx | Sepsis following a procedure |
ICD-10-CM CODES TO IDENTIFY ORGAN DYSFUNCTION
| Code | Code Description |
|---|---|
| A39.1 | Waterhouse-Friderichsen syndrome |
| D65 | Disseminated intravascular coagulation [defibrination syndrome] |
| D69.59 | Other secondary thrombocytopenia |
| D69.6 | Thrombocytopenia, unspecified |
| D69.8 | Other specified hemorrhagic conditions |
| D69.9 | Hemorrhagic condition, unspecified |
| E87.2 | Acidosis |
| E872.0 | Acidosis, unspecified |
| E872.1 | Acute metabolic acidosis |
| E872.2 | Chronic metabolic acidosis |
| E872.9 | Other acidosis |
| E87.4 | Mixed disorder of acid-base balance |
| F05 | Delirium due to known physiological condition |
| F06.0 | Psychotic disorder with hallucinations due to known physiological condition |
| F06.1 | Catatonic disorder due to known physiological condition |
| F06.2 | Psychotic disorder with delusions due to known physiological condition |
| G62.81 | Critical illness polyneuropathy |
| G72.81 | Critical illness myopathy |
| G93.4x | Other and unspecified encephalopathy |
| G93.6 | Cerebral edema |
| G93.82 | Brain death |
| G93.9 | Disorder of brain, unspecified |
| G96.81 | Intracranial hypotension |
| G96.810 | Intracranial hypotension, unspecified |
| G96.811 | Intracranial hypotension, spontaneous |
| G96.819 | Other intracranial hypotension |
| G96.89 | Other specified disorders of central nervous system |
| I46.8 | Cardiac arrest due to other underlying condition |
| I46.9 | Cardiac arrest, cause unspecified |
| I95.1 | Orthostatic hypotension |
| I95.89 | Other hypotension |
| I95.9 | Hypotension, unspecified |
| J80 | Acute respiratory distress syndrome |
| J96.0x | Acute respiratory failure |
| J96.2x | Acute and chronic respiratory failure |
| J96.9x | Respiratory failure, unspecified |
| J98.01 | Acute bronchospasm |
| J98.9 | Respiratory disorder, unspecified |
| J99 | Respiratory disorders in diseases classified elsewhere |
| K59.81 | Ogilvie syndrome |
| K72.0x | Acute and subacute hepatic failure |
| K72.9x | Hepatic failure, unspecified |
| K76.2 | Central hemorrhagic necrosis of liver |
| K76.3 | Infarction of liver |
| K76.7 | Hepatorenal syndrome |
| M35.81 | Multisystem inflammatory syndrome |
| N17.x | Acute kidney failure |
| N19 | Unspecified kidney failure |
| R00.0 | Tachycardia, unspecified |
| R00.1 | Bradycardia, unspecified |
| R03.1 | Nonspecific low blood-pressure reading |
| R06.0 | Dyspnea |
| R06.00 | Dyspnea unspecified |
| R06.03 | Acute respiratory distress |
| R06.09 | Other forms of dyspnea |
| R06.82 | Tachypnea, not elsewhere classified |
| R06.89 | Other abnormalities of breathing |
| R09.02 | Hypoxemia |
| R09.2 | Respiratory arrest |
| R40.0 | Somnolence |
| R40.1 | Stupor |
| R40.20 | Unspecified coma |
| R40.211x | Coma scale, eyes open, never |
| R40.212x | Coma scale, eyes open, to pain |
| R40.213x | Coma scale, eyes open, to sound |
| R40.221x | Coma scale, best verbal response, none |
| R40.222x | Coma scale, best verbal response, incomprehensible words |
| R40.223x | Coma scale, best verbal response, inappropriate words |
| R40.224x | Coma scale, best verbal response, confused conversation |
| R40.231x | Coma scale, best motor response, none |
| R40.232x | Coma scale, best motor response, extension |
| R40.233x | Coma scale, best motor response, abnormal |
| R40.234x | Coma scale, best motor response, flexion withdrawal |
| R40.235x | Coma scale, best motor response, localizes pain |
| R40.242x | Glasgow coma scale score 9-12 |
| R40.243x | Glasgow coma scale score 3-8 |
| R40.244x | Other coma, without documented Glasgow coma scale score, or with partial score reported |
| R40.2A | Nontraumatic coma due to underlying condition |
| R40.3 | Persistent vegetative state |
| R57.x | Shock, not elsewhere classified |
| R65.2x | Severe sepsis |
| T81.12xx | Postprocedural septic shock |