Clinical Subtypes of Sepsis Survivors Predict Readmission and Mortality after Hospital Discharge.
Ann Am Thorac Soc
; 19(8): 1355-1363, 2022 08.
Article
em En
| MEDLINE
| ID: mdl-35180373
ABSTRACT
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
11_ODS3_cobertura_universal
Base de dados:
MEDLINE
Assunto principal:
Alta do Paciente
/
Sepse
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Ann Am Thorac Soc
Ano de publicação:
2022
Tipo de documento:
Article