Inclusion of social determinants of health improves sepsis readmission prediction models

Abstract

Objective Sepsis has a high rate of 30-day unplanned readmissions. Predictive modeling has been suggested as a tool to identify high-risk patients. However, existing sepsis readmission models have low predictive value and most predictive factors in such models are not actionable. Materials and Methods Data from patients enrolled in the AllofUs Research Program cohort from 35 hospitals were used to develop a multicenter validated sepsis-related unplanned readmission model that incorporates clinical and social determinants of health (SDH) to predict 30-day unplanned readmissions. Sepsis cases were identified using concepts represented in the Observational Medical Outcomes Partnership. The dataset included over 60 clinical/laboratory features and over 100 SDH features. Results Incorporation of SDH factors into our model of clinical and demographic features improves model area under the receiver operating characteristic curve (AUC) significantly (from 0.75 to 0.80; P < .001). Model-agnostic interpretability techniques revealed demographics, economic stability, and delay in getting medical care as important SDH predictive features of unplanned hospital readmissions. Discussion This work represents one of the largest studies of sepsis readmissions using objective clinical data to date (8935 septic index encounters). SDH are important to determine which sepsis patients are more likely to have an unplanned 30-day readmission. The AllofUS dataset provides granular data from a diverse set of individuals, making this model potentially more generalizable than prior models. Conclusion Use of SDH improves predictive performance of a model to identify which sepsis patients are at high risk of an unplanned 30-day readmission.

Reporting of Social Determinants of Health in Pediatric Sepsis Studies*

“…In this analysis of pediatric sepsis studies, we found a low frequency of reporting of SDOH and marked variability in categorizations and definitions of SDOH variables. In addition, the number of variables for which data were collected in our review was considerably lower than recent recommendations for SDOH data collection in adult sepsis (6). Consistent and standardized reporting of SDOH in pediatric sepsis studies is needed to understand the role these factors play in the development and severity of sepsis, to compare and extrapolate study results between settings, and to implement policies aimed at improving sepsis outcomes.…”

Predicting Hospital Readmission among Patients with Sepsis using Clinical and Wearable Data

“…Institutional Reviewing Board (IRB) approval was obtained prior to enrollment of patients in the AllofUs Research Program, the data has been deidentified, and has been made available in a secure enclave for research purposes. We included all patients 18 years or older admitted to the hospital for at least two days that had sepsis, which was determined according to the Sepsis-3 criteria, following our previous work on this dataset [15]. We excluded patients who expired or were transitioned to hospice during their admission, or died after hospital discharge.…”

“…Patient clinical and physiological data during their hospital stay as well as Fitbit data pre-and post-discharge following 90 days after their discharge or until their readmission time were used in our analysis. A total of 40 physiological and clinical variables well established by prior sepsis studies were collected for each patient during their hospitalization [15], [16], [17], [18]. We included pre-discharge and postdischarge wearable data including heart rate, basal metabolic rate calories and activity levels averaged per day.…”

Chinese Medicine for Inflammatory Coagulation in Sepsis

“…Western medical treatment of sepsis is currently at a relative bottleneck, and the widespread use of antibiotics has led to widespread drug resistance, making the treatment of sepsis increasingly difficult. Chinese medicine has made many useful discoveries in this area and has shown good promise, such as enhancing antibacterial efficacy and reducing drug resistance, enhancing immunity and regulating immune disorders [1][2].…”