Table 1.
Quality assessment and overall risk of bias of original research articles included in the systematic review
| Study ID | Cohort data source | Cohort description | Ascertainment of sepsis exposure | Minimum 30-day follow-up | Follow-up method and outcome assessment | Was primary study outcome all-cause rehospitalisation | Confounder assessment for rehospitalisation risk factors in sepsis survivors | Non-sepsis comparisons | Overall risk of bias |
|---|---|---|---|---|---|---|---|---|---|
| Braun et al. [27] | MC-large | Sepsis cohort | Yes | Yes | Record linkage | No | Not assessed | No | Low |
| Cakir et al. [28] | SC | Re-hospitalised cohort | Yes | Yes | Notes review | Yes | Not assessed | Yes | Moderate |
| Chang et al. [29] | MC-large | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | Yes | Regression | Yes | Low |
| Deb P et al. [30] | MC-large | Sepsis survivors | Yes | Yes | Record linkage | Yes | Regression | No | Low |
| DeMerle et al. [31] | MC-large | Sepsis survivors | Yes | Yes | Record linkage | No | Not assessed | No | Low |
| DeMerle et al. [32] | SC | Sepsis survivors | Yes | Yes | Notes review | No | Not assessed | No | Low |
| Dick et al. [33] | MC-large | Sepsis and non-sepsis patients | Yes | Yes | Record linkage | No | Not assessed | Yes | Low |
| Dietz et al. [34] | MC | Re-hospitalised cohort | Yes | Yes | EHR | No | Not assessed | Yes | Low |
| Donnelly et al. [12] | MC-large | Sepsis survivors | Yes | Yes | Record linkage | Yes | Regression | No | Low |
| Gadre et al. [35] | MC-large | Sepsis cohort | Yes | Yes | Record linkage | Yes | Regression | No | Low |
| Goodwin et al. [36] | MC-large | Sepsis survivors | Yes | Yes | Record linkage | Yes | Regression | No | Low |
| Guirgis et al. [37] | SC | Sepsis cohort | Yes | Yes | Notes review | No | Not assessed | No | Moderate |
| Hua et al. [38] | MC-large | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | Yes | Regression; competing risk model | Yes | Low |
| Jones et al. [39] | MC-large | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | Yes | Regression | Yes | Low |
| Kim et al. [40] | SC | Re-hospitalised cohort | Yes | Yes | Notes review | No | Regression | No | Moderate |
| Liu et al. [41] | MC-large | Sepsis cohort | Yes | Yes | Record linkage | Yes | Regression; competing risk model | No | Low |
| Mayr et al. [42] | MC-large | Re-hospitalised cohort | Yes | Yes | Record linkage | Yes | Not assessed | Yes | Low |
| Meyer et al. [43] | MC | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | No | Not assessed | Yes | Low |
| Nkemdirim Okere et al. [44] | SC | Sepsis cohort | Yes | Yes | Record linkage | No | Restriction; not assessed | No | Moderate |
| Norman et al. [45] | MC-large | Sepsis survivors | Yes | Yes | Record linkage | Yes | Regression | No | Low |
| Nsutebu et al. [46] | MC | Sepsis cohort | Yes | Yes | Notes review | No | Not assessed | No | Moderate |
| Ortego et al. [47] | SC | Sepsis survivors | Yes | Yes | Record linkage | Yes | Regression | No | Low |
| Prescott et al. [49] | MC-large | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | No | Matching | Yes | Low |
| Prescott et al. [9] | MC-Large | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | Yes | Matching | Yes | Low |
| Prescott et al. [48] | MC-large | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | Yes | Not assessed | Yes | Moderate |
| Prescott et al. [13] | MC-large | Sepsis survivors | Yes | Yes | Record linkage | Yes | Not assessed | No | Moderate |
| Schnegelsberg et al. [50] | SC | Sepsis cohort | Yes | Yes | Record linkage | Yes | Stratification | No | Moderate |
| Singh et al. [51] | SC | Sepsis cohort | Yes | Yes | Notes review | Yes | Regression | No | Moderate |
| Sun A et al. [52] | MC | Sepsis survivors | Yes | Yes | Notes review | Yes | Regression | No | Moderate |
| Sutton et al. [53] | MC-Large | Sepsis cohort | Yes | Yes | Record linkage | No | Not assessed | No | Moderate |
| Vashi et al. [54] | MC-large | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | No | Not assessed | Yes | Low |
| Wang et al. [55] | SC | Sepsis | Yes | Yes | Notes review | No | Regression | Yes | Moderate |
| Weinreich et al. [56] | SC | Sepsis survivors | Yes | Yes | Hospital EHR | Yes | Regression | No | Moderate |
| Wong EL et al. [57] | MC-large | Sepsis and non-sepsis patients in cohort | Yes | Yes | Record linkage | Yes | Not assessed | Yes | Moderate |
| Yende et al. [58] | MC | Sepsis survivors | Yes | Yes | Prospective cohort | No | Not assessed | No | Low |
| Zilberberg et al. [59] | SC | Sepsis survivors | Yes | Yes | Hospital EHR | Yes | Regression | No | Moderate |
The risk of bias was assessed on patient selection, ascertainment of exposure, and ascertainment of outcome domains using a modified Newcastle Ottawa Score (NOS) quality assessment checklist [23]. These domains account for bias with ascertainment, generalisability, measurement of exposure, measurement of risk factors, and selection. Comparability domain of NOS assessed whether excess risk of rehospitalisation in sepsis survivors was quantified and how confounders were considered during study design or analysis with techniques such as matching, restriction or regression models. Outcome domain of NOS assessed bias due to incomplete assessment of outcome or of competing risk outcomes such as mortality and due to censoring. Study-level risk of bias is then reported. Using this information, overall certainty of evidence was assessed as per GRADE system of assessment of evidence about prognosis (see main results) [24]
EHR electronic health record, MC multi-centre, SC single-centre