Sepsis Survivors Readmitted Within 30 Days: Outcomes of a Single-center Retrospective Study

Overview

Journal Crit Care Sci

Specialties Critical Care
General Medicine

Date 2024 Dec 19

PMID 39699389

Authors

Abdelrahman Nanah

Fatima Abdeljaleel

Marcos Vinicius Fernandes Garcia

Kelly Pannikodu

Mohannad Seif

Amy Flowers-Surovi

Naveen Gopal

Divyajot Sadana

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate a cohort of sepsis survivors readmitted within 30 days postdischarge, explore the one-year mortality rate based on different causes of readmission and identify factors associated with increased one-year mortality risk among all sepsis survivors readmitted within this timeframe.

Methods: This was a single-center retrospective cohort study involving adult sepsis survivors who were readmitted within 30 days of discharge. Patients were categorized into 3 groups based on the cause of readmission: same-source infectious readmission, different-source infectious readmission, and noninfectious readmission. The outcome of interest was all-cause one-year mortality. Cox proportional hazard analysis was performed to compare factors associated with one-year mortality.

Results: Of the 1,666 patients admitted with sepsis, 243 (14.5%) were readmitted within 30 days. Readmissions were due to same-source infections (40.7%), different-source infections (21.4%), or noninfectious causes (37.9%). All-cause one-year mortality was 46.9%, with no difference between the groups. Age (HR 1.02; 95%CI: 1.003 - 1.04; p = 0.01), Sequential Organ Failure Assessment score (HR 1.1; 95%CI: 1.02 - 1.18; p = 0.01), discharge to a care facility during index admission (HR 1.6; 95%CI: 1.04 - 2.40; p = 0.03), and malignancy (HR 2.3; 95%CI: 1.5 - 3.7; p < 0.001) were associated with one-year mortality.

Conclusion: Thirty-day readmission in sepsis survivors was common and was associated with a 46.9% one-year mortality rate regardless of readmission cause. Quality improvement patient safety initiatives based on local institutional factors may allow for targeted interventions to improve sepsis survivor outcomes.

References

Iwashyna T, Wesley Ely E, Smith D, Langa K . Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010; 304(16):1787-94. PMC: 3345288. DOI: 10.1001/jama.2010.1553. View

Shankar-Hari M, Saha R, Wilson J, Prescott H, Harrison D, Rowan K . Rate and risk factors for rehospitalisation in sepsis survivors: systematic review and meta-analysis. Intensive Care Med. 2020; 46(4):619-636. PMC: 7222906. DOI: 10.1007/s00134-019-05908-3. View

Iwashyna T, Odden A, Rohde J, Bonham C, Kuhn L, Malani P . Identifying patients with severe sepsis using administrative claims: patient-level validation of the angus implementation of the international consensus conference definition of severe sepsis. Med Care. 2012; 52(6):e39-43. PMC: 3568444. DOI: 10.1097/MLR.0b013e318268ac86. View

Moraes R, Serafini T, Vidart J, Moretti M, Haas J, Pagnoncelli A . Time to clearance of abdominal septic focus and mortality in patients with sepsis. Rev Bras Ter Intensiva. 2020; 32(2):245-250. PMC: 7405735. DOI: 10.5935/0103-507x.20200029. View

Palacios C, Solenkova N, Gorostiaga F . Among sepsis survivors, readmissions due to infections occur sooner and are associated with increased mortality. Anaesthesiol Intensive Ther. 2020; 52(2):105-109. PMC: 10176523. DOI: 10.5114/ait.2020.95070. View

Sun A, Netzer G, Small D, Hanish A, Fuchs B, Gaieski D . Association Between Index Hospitalization and Hospital Readmission in Sepsis Survivors. Crit Care Med. 2015; 44(3):478-87. DOI: 10.1097/CCM.0000000000001464. View

Mayr F, Yende S, Angus D . Epidemiology of severe sepsis. Virulence. 2013; 5(1):4-11. PMC: 3916382. DOI: 10.4161/viru.27372. View

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith C, French C . Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021; 47(11):1181-1247. PMC: 8486643. DOI: 10.1007/s00134-021-06506-y. View

Kurematsu K, Ikematsu Y . Quality of Life of Sepsis Survivors. Crit Care Med. 2023; 51(10):1339-1349. DOI: 10.1097/CCM.0000000000005944. View

10.

Taniguchi L, Pires E, Mauro Vieira Jr J, de Azevedo L . Systemic inflammatory response syndrome criteria and the prediction of hospital mortality in critically ill patients: a retrospective cohort study. Rev Bras Ter Intensiva. 2017; 29(3):317-324. PMC: 5632974. DOI: 10.5935/0103-507X.20170047. View

11.

Prescott H, Langa K, Iwashyna T . Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. JAMA. 2015; 313(10):1055-7. PMC: 4760618. DOI: 10.1001/jama.2015.1410. View

12.

Chang D, Tseng C, Shapiro M . Rehospitalizations Following Sepsis: Common and Costly. Crit Care Med. 2015; 43(10):2085-93. PMC: 5044864. DOI: 10.1097/CCM.0000000000001159. View

13.

Hotchkiss R, Monneret G, Payen D . Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol. 2013; 13(12):862-74. PMC: 4077177. DOI: 10.1038/nri3552. View

14.

Joynes E . More challenges around sepsis: definitions and diagnosis. J Thorac Dis. 2017; 8(11):E1467-E1469. PMC: 5179457. DOI: 10.21037/jtd.2016.11.10. View

15.

Rhee C, Jones T, Hamad Y, Pande A, Varon J, OBrien C . Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. JAMA Netw Open. 2019; 2(2):e187571. PMC: 6484603. DOI: 10.1001/jamanetworkopen.2018.7571. View

16.

Prescott H, Kepreos K, Wiitala W, Iwashyna T . Temporal Changes in the Influence of Hospitals and Regional Healthcare Networks on Severe Sepsis Mortality. Crit Care Med. 2015; 43(7):1368-74. PMC: 4470811. DOI: 10.1097/CCM.0000000000000970. View

17.

Gadre S, Shah M, Mireles-Cabodevila E, Patel B, Duggal A . Epidemiology and Predictors of 30-Day Readmission in Patients With Sepsis. Chest. 2019; 155(3):483-490. DOI: 10.1016/j.chest.2018.12.008. View

18.

Winters B, Eberlein M, Leung J, Needham D, Pronovost P, Sevransky J . Long-term mortality and quality of life in sepsis: a systematic review. Crit Care Med. 2010; 38(5):1276-83. DOI: 10.1097/CCM.0b013e3181d8cc1d. View

19.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

20.

Caraballo C, Ascuntar J, Hincapie C, Restrepo C, Bernal E, Jaimes F . Association between site of infection and in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in Medellin, Colombia. Rev Bras Ter Intensiva. 2019; 31(1):47-56. PMC: 6443304. DOI: 10.5935/0103-507X.20190011. View