Table 3.
Predictors of readmission for specified causes
| Predictor | Anaemia SHR (95% CI) | p | Malaria SHR (95% CI) | p | Heterogeneity of effect between anaemia and malaria | DUS SHR (95% CI) | p value |
|---|---|---|---|---|---|---|---|
| Site* - Mbale | 1.00 | < 0.001 | 1.00 | 0.99 | 0.09 | 1.00 | < 0.001 |
| Blantyre | 0.68 (0.44–1.04) | 0.91 (0.44–1.85) | |||||
| Mulago | 0.56 (0.42–0.75) | 0.95 (0.57–1.56) | 0.14 (0.06–0.34)** | ||||
| Soroti | 0.68 (0.53–0.88) | 1.01 (0.69–1.48) | 0.91 (0.57–1.47) | ||||
| Age at primary admission (per year younger)* | 1.03 (0.99–1.07) | 0.12 | 1.15 (1.07–1.23) | < 0.001 | 0.003 | 0.98 (0.91–1.06) | 0.69 |
| HIV positive* | 2.48 (1.52–4.04) | < 0.001 | 0.85 (0.26–2.76) | 0.79 | 0.05 | – | – |
| Sickle status* - AA | 1.00 | < 0.001 | 1.00 | 0.24 | 0.48 | 1.00 | 0.01 |
| AS | 1.28 (0.77–2.14) | 0.84 (0.34–2.05) | 1.18 (0.45–3.11) | ||||
| SS, unknown at discharge | 0.95 (0.72–1.26) | 0.77 (0.44–1.36) | 0.06 (0.01–0.41) | ||||
| SS, known at discharge | 0.43 (0.30–0.64) | 0.51 (0.26–1.00) | 0.43 (0.20–0.95) | ||||
| Two or more hospital admissions in the last year before primary admission* | 1.67 (1.33–2.11) | < 0.001 | 1.24 (0.88–1.74) | 0.22 | 0.31 | 2.52 (1.63–3.91) | < 0.001 |
| Received blood transfusion ever, prior to this illness* | 1.67 (1.21–2.32) | 0.002 | 2.19 (1.19–4.05) | 0.01 | 0.50 | 2.74 (0.94–7.95) | 0.06 |
| History of cough at primary admission* | 1.07 (0.87–1.33) | 0.51 | 1.12 (0.82–1.52) | 0.49 | 0.94 | 1.21 (0.80–1.83) | 0.36 |
| Indrawing on primary admission* | 1.09 (0.82–1.44) | 0.57 | 1.27 (0.83–1.94) | 0.28 | 0.37 | 1.16 (0.66–2.03) | 0.60 |
| Splenomegaly on admission* - Not palpable | 1.00 | < 0.001 | 1.00 | 0.57 | 0.14 | 1.00 | 0.43 |
| Enlarged | 1.46 (1.18–1.82) | 1.19 (0.87–1.63) | 1.21 (0.76–1.94) | ||||
| Gross | 1.73 (1.23–2.44) | 1.14 (0.64–2.04) | 0.82 (0.40–1.71) | ||||
| Diarrhoea on primary admission | 0.73 (0.52–1.02) | 0.07 | 0.72 (0.42–1.22) | 0.22 | 0.79 | 0.57 (0.27–1.20) | 0.14 |
| Received oral antimalarials in last week before primary admission* | 1.25 (1.02–1.53) | 0.03 | 0.95 (0.71–1.27) | 0.71 | 0.04 | 1.19 (0.82–1.73) | 0.36 |
| Malaria positive at primary admission, no previous blood transfusion | 0.56 (0.41–0.77) | < 0.001 | 1.33 (0.77–2.32) | 0.31 | 0.002 | 1.71 (0.66–4.43) | 0.27 |
| Malaria positive at primary admission, previous blood transfusion | 1.52 (1.10–2.09) | 0.02 | 2.61 (1.50–4.53) | 0.74 | 0.07 | 4.48 (1.70–11.77) | 0.94 |
| Randomised > 24 h after admission* | 1.49 (0.97–2.29) | 0.07 | 0.91 (0.46–1.81) | 0.79 | 0.09 | 1.70 (0.83–3.45) | 0.14 |
| Strata* - TRACT A | 1.00 | 0.29 | 1.00 | 0.08 | 0.003 | 1.00 | 0.47 |
| TRACT B, immediate transfusion | 0.88 (0.64–1.21) | 1.14 (0.76–1.71) | 1.39 (0.80–2.41) | ||||
| TRACT B, triggered transfusion | 1.12 (0.78–1.63) | 1.59 (0.97–2.59) | 1.31 (0.64–2.65) | ||||
| TRACT B, no transfusion | 0.68 (0.41–1.11) | 0.66 (0.33–1.31) | |||||
| Blood pack age (per week older)* | 1.09 (1.00–1.18) | 0.05 | 1.09 (0.96–1.24) | 0.18 | 0.81 | 0.98 (0.83–1.15) | 0.81 |
| Length of stay (per day longer) | 1.02 (0.98–1.05) | 0.38 | 1.02 (0.97–1.08) | 0.41 | 0.76 | 1.02 (0.95–1.10) | 0.60 |
| Missed dose of MVMM, iron folate or cotrimoxazole by 28 days* | 1.34 (1.09–1.64) | 0.005 | 1.25 (0.92–1.69) | 0.16 | 0.34 | 1.67 (1.16–2.40) | 0.01 |
| Admitted > 24 h into another hospital at primary admission | 0.74 (0.55–1.01) | 0.06 | 0.74 | ||||
| Haemoglobin at admission (per g/dL lower) | 1.16 (1.05–1.29 | 0.01 | 0.83 | ||||
| Type of homestead - Urban | 1.00 | 0.002 | 0.0031 | ||||
| Semi urban | 0.46 (0.15–1.42) | ||||||
| Rural | 2.19 (0.99–4.84) | ||||||
| Able to walk unaided before this illness at primary admission | 1.79 (1.01–3.20) | 0.05 | 0.042 | ||||
| Temperature gradient at primary admission | 2.07 (1.28–3.35) | 0.003 | 0.0033 | ||||
| Cotrimoxazole randomisation- cotrimoxazole (vs no cotrimoxazole) | 0.75 (0.57–1.00) | 0.05 | 0.044 | ||||
| Monocytes (per 109/L) at admission | 0.87 (0.77–0.99) | 0.03 | 0.035 | ||||
| Platelets (per 100 × 109/L) at admission | 1.10 (1.02–1.20) | 0.02 | 0.11 | ||||
| Blood pack type- settled (vs whole) | 0.70 (0.49–1.00) | 0.05 | 0.07 | ||||
| Haemoglobinuria in this illness at primary admission | 2.26 (1.37–3.71) | 0.001 | |||||
| Liver > 2 cm below costal margin | 1.47 (0.92–2.38) | 0.11 | |||||
| Positive blood culture at primary admission | 3.25 (1.42–7.46) | 0.01 | |||||
| Granulocytes (per 10 × 109/L) on primary admission | 1.35 (1.09–1.66) | 0.01 |
*selected by initial backwards elimination: retained in final model regardless of significance for control of confounding
** Blantyre and Mulago combined as there were no DUS readmissions in Blantyre
Note: Site and receipt of transfusion are included in all models. Anaemia: including 3381/3894 (87%) children discharged alive and 407/456 (89%) readmitted children (exclusions due to missing data). Malaria: including 3317/3894 (85%) children discharged alive, and 223/252 (88%) readmitted children. DUS: including 2633/3894 (68%) children discharged alive and 121/165 (73%) readmitted children. SHR = sub-hazard ratio from competing risks model (treating death before readmission for the specific cause as a competing risk). TRACT A = severe complicated anaemia (randomised to 30 vs 20 mls/kg transfusion). TRACT B = severe uncomplicated anaemia (randomised to immediate transfusion vs triggered transfusion; those who ultimately received a transfusion are labelled “triggered transfusion” and those who did not “no transfusion”)
HRs for anaemia readmission from stacked model:
1Type of homestead: semi urban 0.86 (0.53–1.41); rural 1.01 (0.66–1.54)
2Able to walk unaided before this illness at primary admission: 0.98 (0.68–1.42)
3Temperature gradient at primary admission: 1.04 (0.70–1.55)
4Cotrimoxazole randomisation- cotrimoxazole (vs no cotrimoxazole): 1.03 (0.83–1.27)
5Monocytes (per 109/L) at admission: 1.02 (0.94–1.11)