Departments of Anesthesiology and Critical Care.
Pediatric Sepsis Program.
Pediatrics. 2023 Jul 1;152(1). doi: 10.1542/peds.2022-060819.
Although children who survive sepsis are at risk for readmission, identification of patient-level variables associated with readmission has been limited by administrative datasets. We determined frequency and cause of readmission within 90 days of discharge and identified patient-level variables associated with readmission using a large, electronic health record-based registry.
This retrospective observational study included 3464 patients treated for sepsis or septic shock between January 2011 and December 2018 who survived to discharge at a single academic children's hospital. We determined frequency and cause of readmission through 90 days post-discharge and identified patient-level variables associated with readmission. Readmission was defined as inpatient treatment within 90 days post-discharge from a prior sepsis hospitalization. Outcomes were frequency of and reasons for 7-, 30-, and 90-day (primary) readmission. Patient variables were tested for independent associations with readmission using multivariable logistic regression.
Following index sepsis hospitalization, frequency of readmission at 7, 30, and 90 days was 7% (95% confidence interval 6%-8%), 20% (18%-21%), and 33% (31%-34%). Variables independently associated with 90-day readmission were age ≤ 1 year, chronic comorbid conditions, lower hemoglobin and higher blood urea nitrogen at sepsis recognition, and persistently low white blood cell count ≤ 2 thous/µL. These variables explained only a small proportion of overall risk (pseudo-R2 range 0.05-0.13) and had moderate predictive validity (area under the receiver operating curve range 0.67-0.72) for readmission.
Children who survive sepsis were frequently readmitted, most often for infections. Risk for readmission was only partly indicated by patient-level variables.
尽管败血症存活患儿有再次入院的风险，但由于行政数据集的限制，确定与再次入院相关的患者水平变量的研究有限。我们使用大型电子健康记录登记处，确定出院后 90 天内的再入院频率和原因，并确定与再入院相关的患者水平变量。
本回顾性观察性研究纳入了 2011 年 1 月至 2018 年 12 月在一家学术性儿童医院因败血症或败血症性休克接受治疗并存活至出院的 3464 例患者。我们通过出院后 90 天确定再入院的频率和原因，并确定与再入院相关的患者水平变量。再入院定义为出院后 90 天内因先前败血症住院再次入院的住院治疗。主要结局是 7 天、30 天和 90 天（主要）再入院的频率和原因。使用多变量逻辑回归检验患者变量与再入院的独立相关性。
在指数败血症住院后，7 天、30 天和 90 天的再入院频率分别为 7%（95%置信区间为 6%-8%）、20%（18%-21%）和 33%（31%-34%）。与 90 天再入院独立相关的变量为年龄≤1 岁、慢性合并症、败血症识别时血红蛋白较低和血尿素氮较高，以及持续白细胞计数≤2000/µL。这些变量仅能解释总体风险的一小部分（伪 R2 范围为 0.05-0.13），且对再入院的预测效度中等（接受者操作特征曲线下面积范围为 0.67-0.72）。
存活的败血症患儿常再次入院，最常见的原因是感染。患者水平变量仅部分提示再入院风险。
