Abstract WP82: Early Readmissions After Hospitalization For Posterior Reversible Encephalopathy Syndrome

Abstract

Background: While most patients with posterior reversible encephalopathy syndrome (PRES) have clinical and radiological reversibility, a significant proportion can have residual neurologic sequelae and longstanding morbidity. The aim of the study was to evaluate the rate, etiologies, and risk factors for 90-day readmissions following hospitalization for PRES. Methods: Data were obtained from the Nationwide Readmissions Database 2016-2018. Hospitalizations with primary diagnosis of PRES, survival to discharge, and known discharge disposition were included in the study. Primary outcome was non-elective readmission within 90 days of discharge. Survival analysis was performed, and independent predictors of readmission were analyzed using multivariable Cox proportional hazards regression. P<0.01 was considered significant. Results: There were 6,155 hospitalizations that met the study inclusion criteria (mean±SD age: 55.9±17.3 years, female: 71.0%). Non-elective readmission within 90 days of discharge occurred in 1,922 (31.2%) patients. The most common reasons for readmissions were infections (20.0%), hypertensive disorders (12.4%), fluid/electrolyte imbalance or renal problems (8.8%), gastrointestinal problems (7.2%), continued/recurrent symptoms related to PRES (6.3%), cardiac problems (5.5%), seizures (4.6%), and acute cerebrovascular events (4.4%). Age was inversely associated with risk of readmissions [hazards ratio (HR): 0.91 for every 10 years increase in age, 95% confidence interval (CI): 0.87-0.95, P <0.001]. Patients with chronic kidney disease (HR: 1.24, 95% CI: 1.06-1.46, P 0.009) and higher Charlson comorbidity index score (HR: 1.10, 95% CI: 1.07-1.14, P <0.001) were more likely to be readmitted. Further, patients with longer length of stay (HR: 1.01, 95% CI: 1.00-1.02, P 0.002) and those not discharged to home (HR: 1.35, 95% CI: 1.16-1.58, P <0.001) during the index hospitalizations were also at a higher risk for readmission. Conclusions: Nearly one-third of patients with PRES get readmitted within 90 days of discharge. While most of the readmissions are due to non-neurologic etiologies, ongoing symptoms related to PRES, seizures, and acute cerebrovascular events contribute to about 15% of all readmissions.