Acute changes in the participant’s condition during early hospitalization, we used vital signs and laboratory test results for the initial 28-hours of hospitalization. The medical record review process did not include vital signs or laboratory findings at later time points, nor sepsis developing at later time period as a result of other major illness. For purposes of this analysis, we did not include organ dysfunction in the definition of sepsis. All simple data discordances were resolved by consensus of abstractors with additional physician-level adjudication for more complex discordances. Initial review of 1531364 1,349 hospital records indicated excellent inter-rater agreement for the presence of a serious infection (kappa = 0.92) and the presence of sepsis (kappa = 0.90) upon hospital presentation.Definition of CovariatesDemographic characteristics evaluated in this analysis included age, sex, race, geographic region, income and education. Behavioral characteristics included tobacco and alcohol use. Tobacco use was defined as current, past and never. We defined alcohol use according to the National Institute on Alcohol Abuse and Alcoholism classification; i.e., moderate (1 drink per day for women or 2 drinks per day for men) and heavy alcohol use (.1 drink per day for women and .2 drinks per day for men). [13]. The parent REGARDS study was designed to oversample African-Americans and residents of the geographic regions referred to as the “Stroke Buckle” (coastal regions of North BIBS39 biological activity Carolina, South Carolina, and Georgia) and “Stroke Belt” (remainder of North Carolina, South Carolina, and Georgia; Alabama, Mississippi, Tennessee, Arkansas and Louisiana). We used the same geographic regions corresponding to “Stroke Buckle”, “Stroke Belt”, and “Non-Belt/Buckle.” Evaluated chronic medical conditions included hypertension, diabetes, dyslipidemia, heart disease, atrial fibrillation, myocardial infarction, stroke, deep vein thrombosis, peripheral artery disease, chronic kidney disease and chronic lung disease. We defined hypertension as systolic blood pressure 140 mm Hg, diastolic blood pressure 90 mm Hg, or the use of antihypertensive agents. Diabetes included individuals with a fasting glucose 126 mg/dL, a non-fasting glucose 200 mg/dL, or the use of insulin or oral hypoglycemic agents. Dyslipidemia included individuals with selfreported high cholesterol or the use of lipid lowering medications. Heart disease consisted of individuals with a self-reported history 1662274 of myocardial infarction, coronary artery bypass grafting, or cardiac angioplasty or stenting, or baseline MNS site electrocardiographic evidence of myocardial infarction. We identified atrial fibrillation based upon participant self-report or baseline electrocardiographic evidence. Participants self-reported the prior history of stroke (including transient ischemic attacks), or deep vein thrombosis. Peripheral artery disease included a self-reported history of lower extremity arterial bypass or leg amputation. Chronic kidney disease included those with an estimated glomerular filtration rate ,60 ml/min/1.73 m2, calculated using baseline serum creatinine and the CKD-EPI equation. [14] REGARDS did not identify chronic lung diseases such as chronic obstructive pulmonary disease, emphysema, or asthma. Therefore we used self-reported pulmonary medications as a surrogate marker for chronic lung disease. Pulmonary medications included beta agonists, leukotriene inhibitors, inhaled corticoster.Acute changes in the participant’s condition during early hospitalization, we used vital signs and laboratory test results for the initial 28-hours of hospitalization. The medical record review process did not include vital signs or laboratory findings at later time points, nor sepsis developing at later time period as a result of other major illness. For purposes of this analysis, we did not include organ dysfunction in the definition of sepsis. All simple data discordances were resolved by consensus of abstractors with additional physician-level adjudication for more complex discordances. Initial review of 1531364 1,349 hospital records indicated excellent inter-rater agreement for the presence of a serious infection (kappa = 0.92) and the presence of sepsis (kappa = 0.90) upon hospital presentation.Definition of CovariatesDemographic characteristics evaluated in this analysis included age, sex, race, geographic region, income and education. Behavioral characteristics included tobacco and alcohol use. Tobacco use was defined as current, past and never. We defined alcohol use according to the National Institute on Alcohol Abuse and Alcoholism classification; i.e., moderate (1 drink per day for women or 2 drinks per day for men) and heavy alcohol use (.1 drink per day for women and .2 drinks per day for men). [13]. The parent REGARDS study was designed to oversample African-Americans and residents of the geographic regions referred to as the “Stroke Buckle” (coastal regions of North Carolina, South Carolina, and Georgia) and “Stroke Belt” (remainder of North Carolina, South Carolina, and Georgia; Alabama, Mississippi, Tennessee, Arkansas and Louisiana). We used the same geographic regions corresponding to “Stroke Buckle”, “Stroke Belt”, and “Non-Belt/Buckle.” Evaluated chronic medical conditions included hypertension, diabetes, dyslipidemia, heart disease, atrial fibrillation, myocardial infarction, stroke, deep vein thrombosis, peripheral artery disease, chronic kidney disease and chronic lung disease. We defined hypertension as systolic blood pressure 140 mm Hg, diastolic blood pressure 90 mm Hg, or the use of antihypertensive agents. Diabetes included individuals with a fasting glucose 126 mg/dL, a non-fasting glucose 200 mg/dL, or the use of insulin or oral hypoglycemic agents. Dyslipidemia included individuals with selfreported high cholesterol or the use of lipid lowering medications. Heart disease consisted of individuals with a self-reported history 1662274 of myocardial infarction, coronary artery bypass grafting, or cardiac angioplasty or stenting, or baseline electrocardiographic evidence of myocardial infarction. We identified atrial fibrillation based upon participant self-report or baseline electrocardiographic evidence. Participants self-reported the prior history of stroke (including transient ischemic attacks), or deep vein thrombosis. Peripheral artery disease included a self-reported history of lower extremity arterial bypass or leg amputation. Chronic kidney disease included those with an estimated glomerular filtration rate ,60 ml/min/1.73 m2, calculated using baseline serum creatinine and the CKD-EPI equation. [14] REGARDS did not identify chronic lung diseases such as chronic obstructive pulmonary disease, emphysema, or asthma. Therefore we used self-reported pulmonary medications as a surrogate marker for chronic lung disease. Pulmonary medications included beta agonists, leukotriene inhibitors, inhaled corticoster.
