The Joint Association of Septicemia and Cerebrovascular Diseases with In-Hospital MortalityAmong Patients with Left Ventricular Assist Device in the United States

•Left ventricular assist device (LVAD) use is increasing in the United States.•LVAD use has been associated infections and other conditions that are preventable•It is important to identify LVAD users at high risk for in-hospital mortality.•In this study, LVAD user had higher risk of septicemia and cerebrovascular diseases.•Patients with both conditions had substantially higher risk of in-hospital mortality Left ventricular assist device (LVAD) is associated with complications such as cerebrovascular diseases (CEVD) as well as septicemia which is often preventable. With their use increasing in the U.S., identifying patients with LVAD who are at high risk for short-term mortality is essential for targeted effective patient management strategies to prevent adverse outcomes. We investigated the individual and joint association of CEVD and septicemia with the risk of in-hospital mortality in patients with LVAD in the U.S. We used data from the National Inpatient Sample from 2004 to 2015 to identify patients ≥18 years of age who underwent LVAD implantation by means of International Classification of Disease, 9th Revision, codes. Multivariable hierarchical negative binomial regression models were used to estimate risk ratios (RR) and 95% confidence intervals (CI) for in-hospital mortality by CEVD-septicemia status. The mean age of the 4638 patients was 56 years, and 23% of them were women. Approximately 13% of patients had septicemia; 7% had CEVD and 2% had both conditions. In models adjusted for demographic, lifestyle/behavior factors and comorbid conditions, the risk of in-hospital mortality was almost threefold higher among patients with septicemia alone (RR=2.84, CI:2.24–3.60); two-and-half fold higher among patients with CEVD alone (RR=2.53, CI:1.85–3.48); and almost fourfold among patients with both septicemia and CEVD (RR=3.76, CI: 2.38–5.94, Pinteraction =