The Risk for Readmission After Sepsis: A Q&A With Dr Shruti Gadre
Almost any infection can lead to sepsis, according to the Centers for Disease Control and Prevention (CDC).1 However, the risk for sepsis is highest in adults age 65 years or older, individuals with chronic medical conditions like diabetes or kidney disease, those with weakened immune systems, and children younger than 1 year.
Sepsis can quickly lead to tissue damage, organ failure, and death without prompt treatment. Moreover, even after treatment, some patients are readmitted to the hospital within 30 days of a sepsis hospitalization.
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Consultant360 spoke with Shruti Gadre, MD, pulmonary critical care physician at Cleveland Clinic and clinical instructor of medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio, about her recent study, “Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Sepsis.”2
She presented her study’s findings at the CHEST 2017 Annual Meeting in Toronto, Canada, and has answered our questions about these findings.
Consultant360: How common is sepsis in the United States? How has this prevalence changed in recent years?
Shruti Gadre: Severe sepsis is a leading cause of death in the United States and the most common cause of death among critically ill patients in non-coronary intensive care units (ICUs). In the United States, the incidence of severe sepsis is estimated to be 300 cases per 100,000 population.
In 2003, a study found an increase in septicemia incidence and septicemia-related deaths over the past 2 decades in United States. This trend is expected to continue due to aging of the population, increasing burden of chronic health conditions, and increased use of immunosuppressive therapy, transplantation, chemotherapy, and invasive procedures.
C360: What are the strongest predictors for readmission after a hospitalization for sepsis?
SG: In our study, 15% of patients were readmitted to the hospital after the index admission for sepsis. The length of hospital stay at the time of the index admission was the strongest predictor of readmission after a hospitalization for sepsis. Other predictors of readmission were a higher comorbidity burden, lower socioeconomic status, presence of metastatic cancer, and need for post-acute care at the time of the index hospitalization.
C360: What are some etiologies of sepsis that hospitalists should be aware of?
SG: The most common etiology of sepsis is respiratory tract infections, particularly pneumonia. Respiratory infections are associated with the highest mortality rate. Other etiologies include bacteremia, genitourinary tract infections, abdominal infections, and so on.
Our study showed that infection was the most common cause of 30-day readmission to the hospital. A total of 22% of patients had sepsis as a cause of readmission to the hospital.
C360: What steps can patients and clinicians take to prevent readmission following a hospitalization for sepsis?
SG: The first step toward preventing readmissions following a hospitalization for sepsis is to understand the etiologies and factors that increase the risk for readmission. We found that infection, particularly sepsis, was an important cause of readmission to the hospital. Additionally, respiratory causes, Clostridium difficile infection, heart failure, and acute kidney injury were other causes. Judicious use of antibiotics and intravenous fluids in patients admitted with sepsis may help prevent the above causes of readmission.
Additionally, a longer length of hospital stay and higher Charlson comorbidity index score were associated with risk for readmission. Patients who had private insurance (reflective of higher socioeconomic status) had a lower risk of readmission. Hence, greater attention should be given to patients with these characteristics at the time of discharge, with emphasis on coordination of care to minimize the risk of readmission.
C360: What clinical impacts will your study have?
SG: Sepsis is a leading admission diagnosis across the United States. Our study is one of the largest studies describing etiology and predictors of 30-day readmission in patients admitted with sepsis. Our study describes that a large number of patients with sepsis (15%) undergo readmission within 30 days of index admission. It identifies common etiologies of readmission and describes risk factors associated with readmission. This study will thus enable clinicians to provide greater attention at the time of discharge to patients who have risk factors for readmission. This will help minimize the high costs associated with readmissions and help mitigate the reduced quality of life that these patients experience.
—Christina Vogt
References:
1. Sepsis. Centers for Disease Control and Prevention. https://www.cdc.gov/sepsis/index.html. Updated August 25, 2017. Accessed on November 2, 2017.
2. Gadre S, Gour A, Shah M, Chaudhury P, Joshi H. Etiologies, trends, and predictors of 30-day readmission in patients with sepsis. CHEST J. 2017;152(4):A410. http://dx.doi.org/10.1016/j.chest.2017.08.436.