Abstract
BackgroundThe 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.MethodA 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.ResultsA 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.ConclusionsMore 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.
Highlights
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
A total of 237 (35,8%; 95% confidence intervals (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, if previously admitted with sepsis within 1 year before the index admission, and treatment with diuretics were independent predictors for readmission. Adjusted subhazard ratio (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
Summary
Since 1992 sepsis has been defined as a clinical syndrome that required at least two Systemic Inflammatory Response Syndrome (SIRS) criteria in the presence of suspected or confirmed infection [2, 3]. Since SIRS lacks sensitivity and is not specific, new criteria for sepsis (Sepsis-3) was introduced in 2016 [4]. Sepsis is defined as a life-threatening organ dysfunction due to a dysregulated host response to infection. A simplified version of SOFA, quickSOFA (qSOFA) was introduced to early identification of patients with infections who are at high risk of poor outcome [4] but has been criticized due to a low sensitivity and poor prognostic accuracy [5]
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