Nanah Abdelrahman, Abdeljaleel Fatima, Garcia Marcos Vinícius Fernandes, Pannikodu Kelly, Seif Mohannad, Flowers-Surovi Amy, Gopal Naveen, Sadana Divyajot
Department of Internal Medicine, Cleveland Clinic Foundation, Fairview Hospital -Cleveland, Ohio, United States.
Department of Quality and Safety, Cleveland Clinic Foundation, Fairview Hospital - Cleveland, Ohio, United States.
Crit Care Sci. 2024 Dec 16;36:e20240116en. doi: 10.62675/2965-2774.20240116-en. eCollection 2024.
To investigate a cohort of sepsis survivors readmitted within 30 days postdischarge, explore the one-year mortality rate based on different causes of readmission and identify factors associated with increased one-year mortality risk among all sepsis survivors readmitted within this timeframe.
This was a single-center retrospective cohort study involving adult sepsis survivors who were readmitted within 30 days of discharge. Patients were categorized into 3 groups based on the cause of readmission: same-source infectious readmission, different-source infectious readmission, and noninfectious readmission. The outcome of interest was all-cause one-year mortality. Cox proportional hazard analysis was performed to compare factors associated with one-year mortality.
Of the 1,666 patients admitted with sepsis, 243 (14.5%) were readmitted within 30 days. Readmissions were due to same-source infections (40.7%), different-source infections (21.4%), or noninfectious causes (37.9%). All-cause one-year mortality was 46.9%, with no difference between the groups. Age (HR 1.02; 95%CI: 1.003 - 1.04; p = 0.01), Sequential Organ Failure Assessment score (HR 1.1; 95%CI: 1.02 - 1.18; p = 0.01), discharge to a care facility during index admission (HR 1.6; 95%CI: 1.04 - 2.40; p = 0.03), and malignancy (HR 2.3; 95%CI: 1.5 - 3.7; p < 0.001) were associated with one-year mortality.
Thirty-day readmission in sepsis survivors was common and was associated with a 46.9% one-year mortality rate regardless of readmission cause. Quality improvement patient safety initiatives based on local institutional factors may allow for targeted interventions to improve sepsis survivor outcomes.
调查脓毒症幸存者出院后30天内再次入院的情况，基于不同的再次入院原因探讨一年死亡率，并确定在此时间段内再次入院的所有脓毒症幸存者中与一年死亡风险增加相关的因素。
这是一项单中心回顾性队列研究，纳入出院后30天内再次入院的成年脓毒症幸存者。根据再次入院原因将患者分为3组：同源感染性再次入院、异源感染性再次入院和非感染性再次入院。感兴趣的结局是全因一年死亡率。进行Cox比例风险分析以比较与一年死亡率相关的因素。
在1666例脓毒症入院患者中，243例（14.5%）在30天内再次入院。再次入院原因包括同源感染（40.7%）、异源感染（21.4%）或非感染性原因（37.9%）。全因一年死亡率为46.9%，各组之间无差异。年龄（HR 1.02；95%CI：1.003 - 1.04；p = 0.01）、序贯器官衰竭评估评分（HR 1.1；95%CI：1.02 - 1.18；p = 0.01）、首次入院期间转至护理机构（HR 1.6；95%CI：1.04 - 2.40；p = 0.03）和恶性肿瘤（HR 2.3；95%CI：1.5 - 3.7；p < 0.001）与一年死亡率相关。
脓毒症幸存者30天再次入院很常见，无论再次入院原因如何，一年死亡率均为46.9%。基于当地机构因素的质量改进患者安全举措可能有助于进行有针对性的干预，以改善脓毒症幸存者的结局。
