Tako-Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes.

Background There are limited data on the presentation of Takotsubo cardiomyopathy ( TTC ) in severe sepsis. Methods and Results This was a retrospective cohort study using the National Inpatient Sample database (2007-2013) of all adults with severe sepsis. TTC was identified in patients with severe sepsis using previously validated administrative codes. The primary outcome was in-hospital mortality, and secondary outcomes included resource utilization and discharge disposition. Regression analysis was performed for the entire cohort and a propensity-matched sample. An exploratory analysis was performed for predictors of TTC incidence and mortality in TTC . During this 7-year period, in 7.1-million hospitalizations for severe sepsis, TTC was diagnosed in 10 746 (0.15%) admissions. TTC was noted more commonly in whites, females, and among 65- to 79-year-old individuals. TTC was independently associated with lower in-hospital mortality in severe sepsis (odds ratio, 0.58; 95% confidence interval, 0.51-0.65). This association was more prominent in females (odds ratio, 0.51; 95% confidence interval, 0.44-0.59]) compared with males (odds ratio, 0.69; 95% confidence interval, 0.55-0.85]). Presentation in later years of the study period, middle-age, female sex, and white race were independent predictors for the diagnosis of TTC . Age ≥80 years, black race, greater comorbidity, and multiorgan dysfunction were independently associated with higher in-hospital mortality among TTC admissions. Conclusions TTC is observed with increasing frequency in severe sepsis and was associated with a significantly lower in-hospital mortality compared with patients without TTC . Presentation in later years of the study period, middle age, female sex, and white race were independent predictors for the diagnosis of TTC in severe sepsis.