FREQUENCY AND PREDICTORS OF READMISSION OF SEPSIS PATIENTS AT TERTIARY CARE HOSPITAL KARACHI

Main Article Content

Zaharan Asif
Nidal Asif
Sajid Atif Aleem

Keywords

Comorbidity, Predictors, Readmission, Sepsis

Abstract

Introduction: Sepsis presents a significant healthcare challenge globally, marked by high morbidity and mortality rates. However, a less-explored aspect is patient readmission after initial discharge. Survivors of sepsis may face complications, requiring further hospitalization. Analyzing patient demographics, clinical factors, comorbidities, and healthcare interventions, this research aims to inform local healthcare practices, contribute to sepsis management strategies, and enhance patient outcomes while reducing healthcare costs.


Objective: To determine the frequency and predictors of readmission of sepsis patients at tertiary care hospital Karachi.


Material & Methods: This particular cross-sectional investigation, carried out within the framework of the study at Ziauddin Hospital, Karachi, from January to December 2020, included 200 patients via consecutive sampling. Inclusion criteria encompassed patients aged 18-80, readmitted within 30 days after initial sepsis hospitalization, with specific medical conditions and positive cultures. Blood samples collected were used to evaluate readmission predictors, including comorbidities (DM, COPD, CHF, CLD, CKD, malignancy, HIV). Data was analyzed using SPSS version 26.


 Results: The mean ± SD of age was 59.64 ±16.60 years. Gender distribution showed 55% male and 45% female participants. Patients with diabetes had a lower readmission rate (31.7%) than those without diabetes (47.9%), indicating statistical significance, with a p-value of 0.034. However, the presence of chronic obstructive pulmonary disease (COPD) didn't significantly affect readmission rates (p = 0.444). Additionally, chronic heart failure (p = 0.195), along with chronic liver disease, chronic kidney disease, malignancy, and HIV, did not significantly impact readmission rates (p = 0.131, p = 0.327, p = 0.082, and p = 0.484, respectively). Furthermore, no statistically significant differences were observed in readmission rates related to ICU admission (p = 0.945) or hypertension (p = 0.279).


Conclusion: The findings of the current study revealed a lower readmission rate among patients with diabetes as a significant finding. Conversely, factors like COPD, chronic heart failure, and various comorbidities did not significantly influence readmissions, and ICU admission and hypertension showed no significant impact. Further research is essential for broader applicability and to enhance patient care.

Abstract 41 | PDF Downloads 17

References

1. Marik PE. The management of sepsis: science & fiction. J Thorac Dis. 2020;12(Suppl 1):S1-4.
2. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). J Am Med Assoc. 2016;315(8):801-10.
3. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease study. Lancet. 2020;395(10219):200-11.
4. Rothman M, Levy M, Dellinger RP, Jones SL, Fogerty RL, Voelker KG, et al. Sepsis as 2 problems: identifying sepsis at admission and predicting onset in the hospital using an electronic medical record-based acuity score. J Crit Care. 2017;38:237-44.
5. Mohr NM, Zebrowski AM, Gaieski DF, Buckler DG, Carr BG. Inpatient hospital performance is associated with post-discharge sepsis mortality. Crit Care. 2020;24(1):626.
6. Brück E, Schandl A, Bottai M, Sackey P. The impact of sepsis, delirium, and psychological distress on self-rated cognitive function in ICU survivors-a prospective cohort study. J Intensive Care. 2018;6:2.
7. Su YX, Xu L, Gao XJ, Wang ZY, Lu X, Yin CF. Long-term quality of life after sepsis and predictors of quality of life in survivors with sepsis. Chin J Traumatol. 2018;21(4):216-23.
8. Shankar-Hari M, Saha R, Wilson J, Prescott HC, Harrison D, Rowan K, et al. Rate and risk factors for rehospitalisation in sepsis survivors: systematic review and meta-analysis. Intensive Care Med. 2020;46(4):619-36.
9. Shankar-Hari M, Harrison DA, Ferrando-Vivas P, Rubenfeld GD, Rowan K. Risk factors at index hospitalization associated with longer-term mortality in adult sepsis survivors. JAMA Netw Open. 2019;2(5):e194900.
10. Courtright KR, Jordan L, Murtaugh CM, Barrón Y, Deb P, Moore S, et al. Risk factors for long-term mortality and patterns of end-of-life care among medicare sepsis survivors discharged to home health care. JAMA Netw Open. 2020;3(2):e200038.
11. Arshad A, Ayaz A, Haroon MA, Jamil B, Hussain E. Frequency and cause of readmissions in sepsis patients presenting to a tertiary care hospital in a low middle income country. Crit Care Explor. 2020;2(2):e0080.
12. Singh A, Bhagat M, George SV, Gorthi R, Chaturvedula C. Factors associated with 30-day unplanned readmissions of sepsis patients: a retrospective analysis of patients admitted with sepsis at a community hospital. Cureus. 2019;11(7):e5118.
13. Goodwin AJ, Ford DW. Readmissions among sepsis survivors: risk factors and prevention. Clin Pulmon Med. 2018;25(3):79.
14. Fatima S, Shamim S, Raffat S, Tariq M. Hospital readmissions in Internal Medicine Specialty: Frequency, associated factors and outcomes. Pak J Med Sc. 2021;37(7):2008.