Clinical Subtypes of Sepsis Survivors Predict Readmission and Mortality after Hospital Discharge
Rationale: Sepsis survivors experience adverse outcomes including high rates of postdischarge mortality and rehospitalization. Given the heterogeneity of the condition, using a person-centered framework to identify subtypes within this population with different risks of postdischarge outcomes may optimize postsepsis care. Objectives: To classify individuals into subtypes and assess the association of subtypes with 30-day rehospitalization and mortality. Methods: We conducted a retrospective observational study between January 2014 and October 2017 among 20,745 patients admitted to one of 12 southeastern U.S. hospitals with a clinical definition of sepsis. We used latent class analysis to classify sepsis survivors into subtypes, which were evaluated against 30-day readmission and mortality rates using a specialized regression approach. A secondary analysis evaluated subtypes against readmission rate for ambulatory care-sensitive conditions. Results: Among 20,745 patients, latent class analysis identified five distinct subtypes as the optimal solution. Clinical subtype was associated with 30-day readmission, with the subtype existing poor health with severe illness and complex needs after discharge demonstrating highest risk (35%) and the subtype low risk, barriers to care demonstrating the lowest risk (9%). Forty-seven percent of readmissions in the subtype poor functional status were for ambulatory care-sensitive conditions, whereas 17% of readmissions in the subtype previously healthy with severe illness and complex needs after discharge, barriers to care were for ambulatory care-sensitive conditions. Subtype was significantly associated with 30-day mortality: highest in for existing poor health with severe illness and complex needs after discharge (8%) and lowest for low risk, barriers to care (0.1%). Conclusions: Sepsis survivors can be classified into subtypes representing nuanced constellations of characteristics, with differential 30-day mortality and readmission risk profiles. Predischarge classification may allow an individualized approach to postsepsis care.
| Errataetall: |
CommentIn: Ann Am Thorac Soc. 2022 Aug;19(8):1271-1272. - PMID 35913466 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:19 |
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| Enthalten in: |
Annals of the American Thoracic Society - 19(2022), 8 vom: 31. Aug., Seite 1355-1363 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Taylor, Stephanie Parks [VerfasserIn] |
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| Links: |
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| Themen: |
Hospital readmission |
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| Anmerkungen: |
Date Completed 03.08.2022 Date Revised 02.08.2023 published: Print CommentIn: Ann Am Thorac Soc. 2022 Aug;19(8):1271-1272. - PMID 35913466 Citation Status MEDLINE |
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| doi: |
10.1513/AnnalsATS.202109-1088OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM337122369 |
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| 500 | |a CommentIn: Ann Am Thorac Soc. 2022 Aug;19(8):1271-1272. - PMID 35913466 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: Sepsis survivors experience adverse outcomes including high rates of postdischarge mortality and rehospitalization. Given the heterogeneity of the condition, using a person-centered framework to identify subtypes within this population with different risks of postdischarge outcomes may optimize postsepsis care. Objectives: To classify individuals into subtypes and assess the association of subtypes with 30-day rehospitalization and mortality. Methods: We conducted a retrospective observational study between January 2014 and October 2017 among 20,745 patients admitted to one of 12 southeastern U.S. hospitals with a clinical definition of sepsis. We used latent class analysis to classify sepsis survivors into subtypes, which were evaluated against 30-day readmission and mortality rates using a specialized regression approach. A secondary analysis evaluated subtypes against readmission rate for ambulatory care-sensitive conditions. Results: Among 20,745 patients, latent class analysis identified five distinct subtypes as the optimal solution. Clinical subtype was associated with 30-day readmission, with the subtype existing poor health with severe illness and complex needs after discharge demonstrating highest risk (35%) and the subtype low risk, barriers to care demonstrating the lowest risk (9%). Forty-seven percent of readmissions in the subtype poor functional status were for ambulatory care-sensitive conditions, whereas 17% of readmissions in the subtype previously healthy with severe illness and complex needs after discharge, barriers to care were for ambulatory care-sensitive conditions. Subtype was significantly associated with 30-day mortality: highest in for existing poor health with severe illness and complex needs after discharge (8%) and lowest for low risk, barriers to care (0.1%). Conclusions: Sepsis survivors can be classified into subtypes representing nuanced constellations of characteristics, with differential 30-day mortality and readmission risk profiles. Predischarge classification may allow an individualized approach to postsepsis care | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a mortality | |
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| 700 | 1 | |a Chou, Shih-Hsiung |e verfasserin |4 aut | |
| 700 | 1 | |a Burns, Ryan |e verfasserin |4 aut | |
| 700 | 1 | |a Kowalkowski, Marc A |e verfasserin |4 aut | |
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