Table 4.
Patient-level factors associated with 30-day hospital readmission in survivors of septic shock.
| No Readmission (N=206) | Readmissions (N=63) | p- value | |
|---|---|---|---|
| Clinical Factors
| |||
| Age, years | 59 ± 18 | 60 ± 16 | 0.75 |
| Female sex (n, %) | 100 (48.5) | 35 (55.6) | 0.33 |
| Race (n, %) | |||
| White | 84 (41.4) | 28 (46.7) | 0.74 |
| Black | 113 (55.7) | 31 (51.7) | |
| Other | 6 (3.0) | 1 (1.7) | |
| Comorbidities (n, %) | |||
| CAD | 25 (12.1) | 8 (12.7) | 0.90 |
| CHF | 26 (12.6) | 9 (14.3) | 0.73 |
| Cirrhosis | 7 (3.4) | 6 (9.5) | 0.05 |
| Chronic renal disease | 23 (11.2) | 8 (12.7) | 0.74 |
| COPD | 16 (7.8) | 5 (7.9) | 0.96 |
| Diabetes mellitus | 68 (33.0) | 17 (27.0) | 0.37 |
| ESRD | 16 (7.8) | 4 (6.4) | 0.71 |
| HIV | 9 (4.4) | 2 (3.2) | 1.00 |
| Hypertension | 95 (46.8) | 31 (49.2) | 0.74 |
| Oncology | 43 (20.9) | 29 (46.0) | <0.001 |
| Transplant | 29 (14.1) | 8 (12.7) | 0.78 |
| Charlson Comorbidity Index | 1 (1 – 3) | 2 (1 – 3) | 0.001 |
| Prior hospitalization within 30 days | 43 (20.9) | 28 (44.4) | <0.001 |
| Illness Severity at Presentation | |||
| Organ dysfunction | |||
| Acute kidney injury (n, %) * | 87 (42.2) | 23 (36.5) | 0.42 |
| Change in mental status | 57 (27.7) | 17 (27.0) | 0.92 |
| Coagulation failure * | 34 (16.5) | 15 (23.8) | 0.19 |
| Hematologic failure * | 18 (8.7) | 7 (11.1) | 0.57 |
| Hepatic failure * | 8 (3.9) | 4 (6.4) | 0.48 |
| Hypoperfusion, lactate (mmol/L) | 4.8 (4.0 – 6.3) | 4.2 (2.5 – 5.3) | 0.02 |
| Refractory hypotension | 70 (34.0) | 25 (39.7) | 0.41 |
| Admission to ICU | 157 (76.2) | 50 (79.4) | 0.60 |
| APACHE II score | 18 ± 7 | 20 ± 6 | 0.05 |
| ED Processes of Care | |||
| Time to antibiotics, minutes | 114 (62 – 198) | 142 (81 – 224) | 0.29 |
| Volume resuscitation, cc | 3150 (2050 – 4350) | 3100 (2050 – 4150) | 0.44 |
| Transfusion (n, %) | 10 (4.8) | 2 (3.2) | 0.57 |
| EGDT initiated | 58 (28.2) | 22 (34.9) | 0.30 |
| Source of sepsis (n, %) | |||
| Bacteremia | 20 (9.7) | 7 (11.1) | 0.75 |
| Pneumonia | 37 (18.0) | 13 (20.6) | 0.63 |
| Genitourinary | 47 (22.8) | 10 (15.9) | 0.24 |
| Gastrointestinal | 40 (19.4) | 13 (20.6) | 0.83 |
| Skin or soft-tissue | 13 (6.3) | 8 (12.7) | 0.10 |
| Hospitalization | |||
| Hospital length of stay | 6 (4 – 13) | 10 (5 – 15) | 0.01 |
| ICU length of stay† | 3 (1 – 5) | 2 (2 – 4) | 0.32 |
| Mechanical ventilation use (n, %) | 46 (22.3) | 8 (12.7) | 0.10 |
| PICC present at discharge | 15 (7.3) | 11 (17.5) | 0.02 |
| Discharge disposition | |||
| Home | 87 (42.2) | 18 (28.6) | 0.15 |
| Home with home services | 61 (29.6) | 24 (38.1) | |
| Skilled care facility | 58 (28.2) | 21 (33.3) | |
Definition of abbreviation: APACHE=acute physiology and chronic health evaluation; CAD=coronary artery disease; CHF=congestive heart failure; COPD=chronic obstructive pulmonary disease; HIV=human immunodeficiency virus; ICU=Intensive Care Unit; PICC=peripherally-inserted central catheter.
Categorical variables are presented as counts and percentages. Continuous variables are presented as means and standard deviations or median and interquartile ranges, as determined by their distribution.
Acute kidney injury defined as serum creatinine ≥ 0.5 mg/dL from baseline. Coagulation failure defined as international normalized ratio > 1.5 or PTT > 60 and hematologic failure as platelets < 100, and hepatic failure as total bilirubin > 4.0 mg/dL (25, 30). Coagulation measures and hepatic function measures were obtained in 78% and 90% of the cohort, respectively; when not assessed, they were presumed to be normal in accord with APACHE II score calculations (32). Refractory hypotension defined as systolic blood pressure ≤ 90 mm Hg after fluid resuscitation or use of vasoactive agents (5–7, 30).
ICU length of stay in subgroup of patients requiring ICU admission.