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BMC Infectious Diseases

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Open Access 01-12-2021 | Septicemia | Research article

Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study

Authors: Peer Oscar Overgaard Stenholt, S. M. Osama Bin Abdullah, Rune Husås Sørensen, Finn Erland Nielsen

Published in: BMC Infectious Diseases | Issue 1/2021

Abstract

Background

The primary objective of our study was to examine predictors for readmission in a prospective cohort of sepsis patients admitted to an emergency department (ED) and identified by the new Sepsis-3 criteria.

Method

A single-center observational population-based cohort study among all adult (≥18 years) patients with sepsis admitted to the emergency department of Slagelse Hospital during 1.10.2017–31.03.2018. Sepsis was defined as an increase in the sequential organ failure assessment (SOFA) score of ≥2. The primary outcome was 90-day readmission. We followed patients from the date of discharge from the index admission until the end of the follow-up period or until the time of readmission to hospital, emigration or death, whichever came first. We used competing-risks regression to estimate adjusted subhazard ratios (aSHRs) with 95% confidence intervals (CI) for covariates in the regression models.

Results

A total of 2110 patients were admitted with infections, whereas 714 (33.8%) suffered sepsis. A total of 52 patients had died during admission and were excluded leaving 662 patients (44.1% female) with a median age of 74.8 (interquartile range: 66.0–84.2) years for further analysis. A total of 237 (35,8%; 95% CI 32.1–39.6) patients were readmitted within 90 days, and 54(8.2%) had died after discharge without being readmitted. We found that a history of malignant disease (aSHR 1,61; 1.16–2.23), if previously admitted with sepsis within 1 year before the index admission (aSHR; 1.41; 1.08–1.84), and treatment with diuretics (aSHR 1.51; 1.17–1.94) were independent predictors for readmission. aSHR (1.49, 1.13–1.96) for diuretic treatment was almost unchanged after exclusion of patients with heart failure, while aSHR (1.47, 0.96–2.25) for malignant disease was slightly attenuated after exclusion of patients with metastatic tumors.

Conclusions

More than one third of patients admitted with sepsis, and discharged alive, were readmitted within 90 days. A history of malignant disease, if previously admitted with sepsis, and diuretic treatment were independent predictors for 90-day readmission.

Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of global incidence and mortality of hospital-treated Sepsis. Current estimates and limitations. Am J Respir Crit Care Med. 2016;193(3):259–72. https://doi.org/10.1164/rccm.201504-0781OC.CrossRefPubMed

Levy MM, Fink MP, Marshall JC, et al. SCCM/ESICM/ACCP/ATS/SIS. Crit Care Med. 2003;31(4):1250–6. https://doi.org/10.1097/01.CCM.0000050454.01978.3B.CrossRefPubMed

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55. https://doi.org/10.1378/chest.101.6.1644.CrossRefPubMed

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10. https://doi.org/10.1001/jama.2016.0287.CrossRefPubMedPubMedCentral

Abdullah SMOB, Sørensen RH, Dessaus RBC, Wiese L, Nielsen FE. Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study. Emerg Med J. 2019;36:722–8.PubMed

Maley JH, Mikkelsen ME. Short-term gains with long-term Consequenses: the evolving story of Sepsis survivorship. Clin Chest Med. 2016;37(2):367–80. https://doi.org/10.1016/j.ccm.2016.01.017.CrossRefPubMed

Hines AL, Barrett ML, Jiang HJ, Steiner CA. Conditions with the largest number of adult hospital readmissions by payer, 2011. HCUP Statistical Brief, vol. 172; 2014.

Goodwin AJ, Rice DA, Simpson KN, Ford DW. Frequency, cost, and risk factors of readmissions among severe Sepsis survivors. Crit Care Med. 2015;43(4):738–46. https://doi.org/10.1097/CCM.0000000000000859.CrossRefPubMedPubMedCentral

Schmidt M, Schmidt SAJ, Adelborg K, Sundbøll J, Laugesen K, Ehrenstein V, et al. The Danish health care system and epidemiological research: from health care contacts to database records. Clin Epidemiol. 2019;11:563–91. https://doi.org/10.2147/CLEP.S179083.CrossRefPubMedPubMedCentral

10.

Thygesen SK, Christiansen CF, Christensen S, Lash TL, Sorensen HT. The predictive value of ICD-10 diagnostic coding used to assess Charlson comorbidity index conditions in the population-based Danish National Registry of patients. BMC Med Res Methodol. 2011;11(1):83. https://doi.org/10.1186/1471-2288-11-83.CrossRefPubMedPubMedCentral

11.

Schmidt M, Pedersen L, Sørensen HT. The Danish civil registration system as a tool in epidemiology. Eur J Epidemiol. 2014;29(8):541–9. https://doi.org/10.1007/s10654-014-9930-3.CrossRefPubMed

12.

Shebehe J, Hansson A. High hospital readmission rates for patients aged >/=65 years associated with low socioeconomic status in a Swedish region: a cross-sectional study in primary care. Scand J Prim Health Care. 2018;36(3):300–7. https://doi.org/10.1080/02813432.2018.1499584.CrossRefPubMedPubMedCentral

13.

Morandi A, Bellelli G, Vasilevskis EE, Turco R, Guerini F, Torpilliesi T, et al. Predictors of rehospitalization among elderly patients admitted to a rehabilitation hospital: the role of polypharmacy, functional status, and length of stay. J Am Med Dir Assoc. 2013;14(10):761–7. https://doi.org/10.1016/j.jamda.2013.03.013.CrossRefPubMedPubMedCentral

14.

Rodriguez-Artalejo F, Guallar-Castillon P, Herrera MC, et al. Social network as a predictor of hospital readmission and mortality among older patients with heart failure. J Card Fail. 2006;12(8):621–7. https://doi.org/10.1016/j.cardfail.2006.06.471.CrossRefPubMed

15.

Donnelly JP, Hohmann SF, Wang HE. Unplanned readmissions after hospitalization for severe Sepsis at Academic Medical Center-affiliated hospitals. Crit Care Med. 2015;43(9):1916–27. https://doi.org/10.1097/CCM.0000000000001147.CrossRefPubMedPubMedCentral

16.

Deb P, Murtaugh CM, Bowles KH, Mikkelsen ME, Khajavi HN, Moore S, et al. Does early follow-up improve the outcomes of Sepsis survivors discharged to home health care? Med Care. 2019;57(8):633–40. https://doi.org/10.1097/MLR.0000000000001152.CrossRefPubMed

17.

Chang DW, Tseng C, Shapiro MF. Rehospitalization following Sepsis: common and costly. Crit Care Med. 2015;43(10):2085–93. https://doi.org/10.1097/CCM.0000000000001159.CrossRefPubMedPubMedCentral

18.

Jones TK, Fuchs BD, Small DS, Halpern SD, Hanish A, Umscheid CA, et al. Post-acute care use and hospital readmission after Sepsis. Ann Am Thorac Soc. 2015;12(6):904–13. https://doi.org/10.1513/AnnalsATS.201411-504OC.CrossRefPubMedPubMedCentral

19.

Liu V, Lei XL, Prescott HC, Kipnis P, Iwashyna TJ, Escobar GJ. Hospital readmission and healthcare utilization following Sepsis in community settings. J Hosp Med. 2014;9(8):502–7. https://doi.org/10.1002/jhm.2197.CrossRefPubMedPubMedCentral

20.

Stöllberger C, Schneider B. Readmission diagnoses after hospitalization for severe Sepsis and other acute medical conditions. JAMA. 2015;313(10):1055–7.CrossRef

21.

Singh A, Bhagat M, George SV, Gorthi R, Chaturvedula C. Factors associated with 30-day unplanned readmissions of Sepsis patients: a retrospective analysis of patients admitted with Sepsis at a community hospital. Cureus. 2019;11(7):e5118. https://doi.org/10.7759/cureus.5118.CrossRefPubMedPubMedCentral

22.

Gadre SK, Shah M, Mireles-Cabodevila E, Patel B, Duggal A. Epidemiology and predictors of 30-day readmission in patients with Sepsis. Chest. 2019;155(3):483–90. https://doi.org/10.1016/j.chest.2018.12.008.CrossRefPubMed

23.

Zilberberg MD, Shorr AF, Micek ST, Kollef MH. Risk factors for 30-day readmission among patients with culture-positive severe Sepsis and septic shock: a retrospective cohort study. J Hosp Med. 2015;10(10):678–85. https://doi.org/10.1002/jhm.2420.CrossRefPubMed

24.

Norman BC, Cooke CR, Ely EW, Graves JA. Sepsis-associated 30-day risk-standardized readmissions: analysis of a Nationwide Medicare sample. Crit Care Med. 2017;45(7):1130–7. https://doi.org/10.1097/CCM.0000000000002476.CrossRefPubMedPubMedCentral

25.

Ruiz B, García M, Aguirre U, Aguirre C. Factors predicting hospital readmissions related to adverse drug reactions. Eur J Clin Pharmacol. 2008;64(7):715–22. https://doi.org/10.1007/s00228-008-0473-y.CrossRefPubMed

26.

Nair NP, Chalmers L, Peterson GM, Bereznicki BJ, Castelino RL, Bereznicki LR. Hospitalization in older patients due to advers drug reactions – the need for a prediction tool. Clin Interv Aging. 2016;11:497–505.CrossRef

27.

Bénard-Laribière A, Miremont-Salamé G, Pérault-Pochat MC, Noize P, Haramburu F. Incidence of hospital admissions due to adverse drug reaction in France: the EMIR study. Fundam Clin Pharmacol. 2015;29(1):106–11. https://doi.org/10.1111/fcp.12088.CrossRefPubMed

28.

Sadeq A, Sadeq A, Sadeq A, Alkhidir IY, Aburuz S, Mellal AA, et al. Risk factors for hospital readmission of patients with heart failure: a cohort study. J Pharm Bioallied Sci. 2020;12(3):335–43. https://doi.org/10.4103/jpbs.JPBS_323_20.CrossRefPubMedPubMedCentral

29.

Ravioli S, Gygli R, Funk GC, Exadaktylos A, Lindner G. Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis. Eur J Intern Med. 2020. https://doi.org/10.1016/j.ejim.2020.12.003.

30.

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486–552. https://doi.org/10.1097/CCM.0000000000002255.CrossRefPubMed

31.

Klompas M, Calandra T, Singer M. Antibiotics for sepsis – finding the equilibrium. JAMA. 2018;320(14):1433–4. https://doi.org/10.1001/jama.2018.12179.CrossRefPubMed

32.

Connolly M, Adams C. Source control in Sepsis. In: Ward N, Levy M, editors. Sepsis (pp 207–212) respiratory medicine. Cham: Humana Press; 2017. https://doi.org/10.1007/978-3-319-48470-9.

Title: Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study
Authors: Peer Oscar Overgaard Stenholt
S. M. Osama Bin Abdullah
Rune Husås Sørensen
Finn Erland Nielsen
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Septicemia
Septicemia
Diuretics
Published in: BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-021-06007-9

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Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study

Abstract

Background

Method

Results

Conclusions

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Abstract

Background

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Conclusions

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