#1604 LACE index as predictors of 30 day rehospitalisation among patients on maintenance hemodialysis, cohort study

Abstract

Abstract Background and Aims Over 35% of patients on maintenance dialysis are readmitted to the hospital within 30 days of hospital discharge. Validated risk assessment tools such as the LACE index (Length of stay, Acuity of admission, Co-morbidities, and Emergency department visits) have been developed to identify patients at high risk of hospital readmission in non-dialysis patients but have not been tested in dialysis patients. Method Data was collected from electronic medical records of patients on maintenance hemodialysis in Diaverum outpatient clinics hospitalized during 2023. Data included Age, gender, duration of hospital stay, Charlson comorbidity index (CCS), urgent or planned, and cause of Hospitalization. Multivariable logistic regression models with 30-day readmission for the same reason as the dependent outcome were used to identify readmission risk factors and whether the LACE score validly predicts 30-day rehospitalization among our cohort. Results Among (4829) patients received dialysis in Diaverum Saudi Arabia during 2023. (1487) episodes of hospitalization were reported due to various reasons rate of hospitalization was 0.54 Episodes per patient-years at risk, and 372(25%) of hospitalized patients were re-hospitalized for the same reason within 30 days. The proportion of patients with 30 days of rehospitalization for the same reason was higher in patients with post-initial discharge LACE index ≥10 in comparison to patients with LACE index<10, 348(32.6%) & 24(5.7) respectively P-VALUE<0.001. also significantly higher in patients ≥65years old than those younger 163(27.7%) &209(23.3%) respectively P-VALUE<0.05, those in high risk group (defined as those with higher comorbidity index ≥6 and/or lower Individual Patient Performance Score<75) than those who are not in high risk group 215(35%) & 157(17.9%) respectively P-VALUE<0.001. Multivariate logistic regression including covariates significantly associated with higher 30-day rehospitalization to avoid confounder effect with model including ( age, gender, dialysis duration, body mass index, comorbidity index, diabetes, vascular access, cause of hospitalization and inclusion in high-risk group ) showed significantly higher rehospitalization in patients with post-initial discharge LACE index ≥10 in comparison to patients with LACE index<10 ODDS RATIO (95%CI) 7.95(5.1-12.5) P-VALUE<0.001. independent of other covariates in the model Conclusion LACE index at discharge is an independent predictor of (30) days re-hospitalization in patients on maintenance Hemodialysis. Further analysis needed for a specific model for HD patients taking into consideration the unique characteristics of this cohort of patients.