The Relationship Between Index Hospitalizations, Sepsis, and Death or Transition to Hospice Care During 30-Day Hospital Readmissions

Dietz, Brett W.; Jones, T.K.; Small, Dylan S.; Gaieski, David F.; Mikkelsen, Mark E.

doi:10.1097/mlr.0000000000000669

Cited by 11 publications

(13 citation statements)

References 46 publications

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“… 10 Increased risk of outcome with a lower blood hemoglobin level at index sepsis admission in the score is analogous to the association observed with a lower blood hemoglobin level at critical care discharge. 36 , 37 , 38 We contend that the admission blood hemoglobin level may also represent chronic health status.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Key Points Question Could a prognostic score for unplanned rehospitalizations or death in the first year after hospital discharge of adult sepsis survivors be developed using index sepsis illness characteristics as predictors? Findings In this cohort study of 94 748 patients in adult general critical care units in England, unplanned rehospitalization or death in the first year after hospital discharge occurred for 51% of patients in the derivation cohort and 53% of patients in the validation cohort. The prognostic score is calculated using 8 predictors: previous hospitalizations in the preceding year, age, socioeconomic status, preadmission dependence, number of comorbidities, admission type, site of infection, and admission blood hemoglobin level. Meaning This score provides clinically useful information for prognosis discussions and planning follow-up care for sepsis survivors.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…All 36 studies met the minimum follow-up duration of 30 days [9,12,13,], that we considered as adequate for outcome of interest to occur. Ten studies report a sepsis cohort starting from their index admission [27,35,37,41,44,46,50,51,53,55], twelve studies report a sepsis survivor cohort [9, 12, 30-32, 36, 45, 47, 52, 56, 58, 59], and four report a rehospitalisation cohort [28,34,40,42]. Ten were single-centre studies [28,37,40,44,47,50,51,55,56,59] with greater risk of bias compared to 21 studies [9, 12, 13, 27, 29-31, 33, 35, 36, 38, 39, 41, 42, 45, 48, 49, 53, 54, 57] that used large multi-centre databases with greater generalizability.…”

Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Analyses stratified by the presence of a cancer diagnosis, which has previously been shown to be associated with in-hospital mortality and hospice referral among sepsis readmissions, were also performed. 8 For all analyses, given the large sample size, statistical testing was 2-sided with a significance threshold of P < .001, and results were preferentially judged by their clinical relevance. RStudio, version 3.3.1 (R Core Team), was used for descriptive statistics and statistical analyses.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…3 However, sepsis survivorship often comes at a cost, namely reduced health-related quality of life, cognitive and functional impairments, 4 increased risks of hospital readmission, [5][6][7] and long-term mortality risk. [8][9][10][11] Amid a heightened awareness of these long-term consequences, 12,13 improving the quality of post-sepsis care has become a global priority. 13 Efforts to improve outcomes among sepsis survivors have largely focused on preventing or mitigating postdischarge morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care

et al. 2020

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IMPORTANCE Despite a growing recognition of the increased mortality risk among sepsis survivors, little is known about the patterns of end-of-life care among this population. OBJECTIVE To describe patterns of end-of-life care among a national sample of sepsis survivors and identify factors associated with long-term mortality risk and hospice use. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care using national Medicare administrative, claims, and home health assessment data from 2013 to 2014. The initial and final primary analyses were conducted in July 2017 and from July to August 2019, respectively. EXPOSURES Sepsis hospital discharge and 1 or more home health assessments within 1 week. MAIN OUTCOMES AND MEASURES Outcomes were 1-year mortality among all sepsis survivors and hospitalization in the last 30 days of life, death in an acute care hospital, and hospice use among decedents. Multivariate logistic regression was used to identify factors associated with 1-year mortality and hospice use. RESULTS Among 87 581 sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care, 49 323 (56.3%) were aged 75 years or older, 69 499 (79.4%) were non-Hispanic white, and 48 472 (55.3%) were female. Among the total survivors, 24 423 (27.9%) people died within 1 year of discharge, with a median (interquartile range) survival time of 119 (51-220) days. Among these decedents, 16 684 (68.2%) were hospitalized in the last 30 days of life, 6560 (26.8%) died in an acute care hospital, and 12 573 (51.4%) were enrolled in hospice, with 5729 (45.6%) using hospice for 7 or fewer days. Several factors were associated with 1-year mortality, including a cancer diagnosis (odds ratio [OR], 3.66; 95% CI, 3.50-3.83; P < .001), multiple dependencies of activities of daily living or instrumental activities of daily living (OR, 2.80; 95% CI, 2.57-3.05; P < .001), and an overall poor health status (OR, 2.21; 95% CI, 2.01-2.44; P < .001) documented on home health assessment. Among the decedents, cancer was associated with hospice use (OR, 2.25; 95% CI, 2.11-2.41; P < .001), patients aged 85 years or older (OR, 1.49; 95% CI, 1.37-1.61; P < .001), and living in an assisted living setting (OR, 1.93; 95% CI, 1.69-2.19; P < .001). CONCLUSIONS AND RELEVANCE The findings of this study suggest that death within 1 year after sepsis discharge may be common among Medicare beneficiaries discharged to home health care. Although 1 in 2 decedents used hospice, aggressive care near the end of life and late hospice referral were common. Readily identifiable risk factors suggest opportunities to target efforts to improve palliative and end-of-life care among high-risk sepsis survivors.

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The Relationship Between Index Hospitalizations, Sepsis, and Death or Transition to Hospice Care During 30-Day Hospital Readmissions

Abstract: We identified factors, including sepsis and shock during the index hospitalization, associated with death or transition to hospice care during readmission. Infection was frequently implicated as the cause of a readmission that ended in death.

Cited by 11 publications

References 46 publications

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

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

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

Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care

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