From the Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City.
Neurology. 2022 Oct 31;99(18):e2072-e2080. doi: 10.1212/WNL.0000000000201086.
To evaluate the frequency, etiologies, and risk factors for 90-day readmissions after hospitalization for posterior reversible encephalopathy syndrome (PRES).
Data were obtained from the Nationwide Readmissions Database 2016-2018. Patients with a primary diagnosis of PRES, survival to discharge, and known discharge disposition were included. The primary outcome was nonelective readmission within 90 days of discharge. Survival analysis was performed, and independent predictors of readmission were analyzed using multivariable Cox proportional hazards regression.
Based on the study inclusion criteria, 6,155 eligible patients were included (mean ± SD age: 55.9 ± 17.3 years, female: 71.0%). Nonelective readmission within 90 days of discharge occurred for 1,922 (31.2%) patients. Of these, 617 readmissions were due to PRES-related or neurologic etiologies and the remaining 1,305 readmissions were due to non-neurologic conditions. In multivariable analysis, age was inversely associated with the risk of readmission (hazards ratio [HR] 0.92 for every 10 years increase in age, 95% CI 0.88-0.97). Patients with diabetes (HR 1.21, 95% CI 1.04-1.42), systemic lupus erythematosus (HR 1.42, 95% CI 1.03-1.96), acute kidney injury (HR 1.28, 95% CI 1.11-1.47), and a higher Charlson comorbidity index score (HR 1.09, 95% CI 1.06-1.13) were more likely to be readmitted. Furthermore, patients admitted at large bed size hospitals (HR 1.19, 95% CI 1.03-1.39), those with a longer length of stay (HR 1.01, 95% CI: 1.00-1.02), and those not discharged to home (HR 1.33, 95% CI: 1.14-1.55) during the index hospitalization were also at a higher risk for readmission.
Nearly one-third of patients hospitalized because of PRES are readmitted within 90 days of discharge, and approximately one-third of these readmissions are due to PRES-related or neurologic etiologies. Younger age, a higher comorbidity burden, a longer length of hospital stay, and discharge disposition other than to home are independently associated with the risk of readmission.
评估因后部可逆性脑病综合征（PRES）住院后 90 天内再次入院的频率、病因和危险因素。
数据来自 2016 年至 2018 年的全国再入院数据库。纳入有原发性 PRES 诊断、存活至出院且已知出院去向的患者。主要结局是出院后 90 天内非选择性再入院。采用生存分析，使用多变量 Cox 比例风险回归分析再入院的独立预测因素。
根据研究纳入标准，共纳入 6155 名符合条件的患者（平均年龄±标准差：55.9±17.3 岁，女性：71.0%）。出院后 90 天内有 1922 名（31.2%）患者再次入院。其中，617 次再入院是由于 PRES 相关或神经系统病因，其余 1305 次再入院是由于非神经系统疾病。多变量分析显示，年龄与再入院风险呈负相关（每增加 10 岁，风险比 [HR] 为 0.92，95%CI 为 0.88-0.97）。患有糖尿病（HR 1.21，95%CI 1.04-1.42）、系统性红斑狼疮（HR 1.42，95%CI 1.03-1.96）、急性肾损伤（HR 1.28，95%CI 1.11-1.47）和更高的 Charlson 合并症指数评分（HR 1.09，95%CI 1.06-1.13）的患者更有可能再次入院。此外，在大床位医院住院（HR 1.19，95%CI 1.03-1.39）、住院时间较长（HR 1.01，95%CI：1.00-1.02）和未出院回家（HR 1.33，95%CI：1.14-1.55）的患者再次入院的风险也更高。
近三分之一因 PRES 住院的患者在出院后 90 天内再次入院，其中约三分之一的再入院是由于 PRES 相关或神经系统病因。年龄较小、合并症负担较高、住院时间较长以及出院去向不是回家与再入院风险独立相关。
