Rate and risk factors for rehospitalisation in sepsis survivors: systematic review and meta-analysis

Abstract

Purpose: Sepsis survivors have a higher risk of rehospitalisation and of long-term mortality. We assessed the rate, diagnosis, and independent predictors for rehospitalisation in adult sepsis survivors. Methods: We searched for non-randomized studies and randomized clinical trials in MEDLINE, Cochrane Library, Web of Science, and EMBASE (OVID interface, 1992-October 2019). The search strategy used controlled vocabulary terms and text words for sepsis and hospital readmission, limited to humans, and English language. Two authors independently selected studies and extracted data using predefined criteria and data extraction forms. Results: The literature search identified 12,544 records. Among 56 studies (36 full and 20 conference abstracts) that met our inclusion criteria, all were non-randomised studies. Studies most often report 30-day rehospitalisation rate (mean 21.4%, 95% confidence interval [CI] 17.6-25.4%; N = 36 studies reporting 6,729,617 patients). The mean (95%CI) rehospitalisation rates increased from 9.3% (8.3-10.3%) by 7 days to 39.0% (22.0-59.4%) by 365 days. Infection was the most common rehospitalisation diagnosis. Risk factors that increased the rehospitalisation risk in sepsis survivors were generic characteristics such as older age, male, comorbidities, non-elective admissions, hospitalisation prior to index sepsis admission, and sepsis characteristics such as infection and illness severity, with hospital characteristics showing inconsistent associations. The overall certainty of evidence was moderate for rehospitalisation rates and low for risk factors. Conclusions: Rehospitalisation events are common in sepsis survivors, with one in five rehospitalisation events occurring within 30 days of hospital discharge following an index sepsis admission. The generic and sepsis-specific characteristics at index sepsis admission are commonly reported risk factors for rehospitalisation.

Development, Validation, and Clinical Utility Assessment of a Prognostic Score for 1-Year Unplanned Rehospitalization or Death of Adult Sepsis Survivors

“…As part of development work for this analysis, we published the operational definition for sepsis from this database, 3 long-term mortality in the derivation cohort, 8 and systematic reviews to identify key predictors. 6 , 7 Our method of handling comorbidities functions even when patients have 2 or more comorbidities, is transferable between health care systems that use different comorbidity definitions, and the incremental risk with increasing numbers of comorbidities has clinical validity. We followed the recommendations by Steyerberg and colleagues 27 for bootstrap validations.…”

“…Statistical analysis was performed from July 5 to October 31, 2019. Potential generic predictors and sepsis-specific predictors 8 associated with either all-cause rehospitalization or 1-year mortality among sepsis survivors were identified from systematic reviews 6 , 7 (eTable 1 in the Supplement ). The generic predictors were as follows: the Acute Physiology and Chronic Health Evaluation (APACHE) II physiology score 20 in 5-point increments, the hospital length of stay in 7-day increments, the number of hospitalizations in the year preceding the index sepsis admission (base category = none), age in 10-year increments (base category = 18-30 years), race/ethnicity (base category = White), quintiles of 2015 Index of Multiple Deprivation (IMD2015) in England as a proxy for socioeconomic status (base category = least deprived), prehospitalization dependence status (base category = no dependence), the number of comorbidities (base category = none), surgical status (base category = medical), admission blood hemoglobin level (≤7, 7.1-11, and 9.1-11 g/dL, with a base category of >11 g/dL [to convert to grams per liter, multiply by 10.0]), and admission blood lactate concentrations (18-36 mg/dL and >36 mg/dL, with a base category of <18 mg/dL [to convert to millimoles per liter, multiply by 0.111]), with sex (base category = female) and hospital type (base category = nonuniversity) as binary predictors.…”

“… 7 A systematic review of rehospitalization risk factors (predictors) for sepsis survivors that included 56 studies highlighted generic characteristics (such as older age, male sex, comorbidities, nonelective admissions, and hospitalizations prior to index sepsis admission) and index sepsis admission characteristics (such as infection and illness severity) as consistent predictors across studies. 6 The long-term mortality risk for sepsis survivors is also associated with these acute illness characteristics. 8 More important, because health care professionals will know these acute illness characteristics before the sepsis survivors are discharged, it is feasible to use these characteristics to predict the risk of these patient-centered adverse outcomes.…”

Inpatient hospital performance is associated with post-discharge sepsis mortality

“…Many sepsis survivors have persistent neurocognitive deficits, neuromuscular weakness, symptoms of depression and post-traumatic stress disorder, and poor quality of life [ 6 – 10 ]. Readmissions after discharge are common (21% within 30 days) [ 11 ], and sepsis survivors have increased post-discharge mortality [ 12 – 14 ]. Post-discharge deaths have been associated with premorbid health status and hospital factors [ 15 , 16 ], but it is unclear whether these factors are modifiable, and whether hospital care can alter the post-discharge course.…”

Clinical spectrum and risk factors for hospital-acquired septicemia in a tertiary care centre of North-East India

“…[ 25 27 ] Shankar-Hari revealed increased age as one of the common risk factors for rehospitalization too. [ 28 ] It might be due to the fact that older patients would have decreased immunity due to immunosenescence. [ 29 ] These above explained risk factors suggest that specific infection control practices should be followed while handling these patients to prevent progression of sepsis.…”