Background
Methods
Design and setting
Definitions
Inclusion and exclusion criteria
Patients with infections
Data collection process
Statistical analyses
Results
Study population
Readmission and baseline characteristics
Readmitted N = 237 (35.8%) | Not readmitted N = 425 (64.2%) | Difference (95% CI) | |
---|---|---|---|
Female gender; n(%)a | 105 (44.3) | 187 (44.0) | 0.3(÷7.5–8.2) |
Age; median years (IQR)a | 74.9 (64.7–83.9) | 74.8 (66.6–84.4) | 0.1(÷1.9–2.3) |
Medical history | |||
Charlson Comorbidity Score; n(%) | |||
0 | 46 (19.4) | 125 (29.4) | 10.0 (3.4–16.6) |
1–2 | 108 (45.6) | 210 (49.4) | 3.8(÷11.7–4.1) |
3 + b | 83 (35.0) | 90 (21.2) | 13.8 (6.6–21.0) |
Heart failurea | 39 (16.5) | 63 (14.8) | 1.7(÷4.1–7.5) |
Myocardial infarction/Ischemic heart diseasea | 33 (13.9) | 53 (12.5) | 1.4(÷4.0–6.8) |
Chronic obstructive pulmonary diseasea | 64 (27.0) | 96 (22.6) | 4.4(÷2.5–11.3) |
Malignant diseaseb,c | 47 (19.8) | 47 (11.0) | 8.8 (2.9–14.9) |
Diabetesa,d | 55 (23.2) | 85 (20.0) | 3.2(÷3.4–9.8) |
Kidney diseasea,e | 24 (10.1) | 33 (7.8) | 2.3(÷2.3–6.9) |
Liver diseasea,f | 3 (1.3) | 10 (2.4) | 1.1(÷1.1–3.3) |
Cerebrovascular diseasea,g | 49 (20.7) | 75 (17.7) | 3.0(÷3.3–9.3) |
Hypertensiona | 89 (37.6) | 154 (36.2) | 1.4(÷6.2–9.1) |
History of sepsis within last year before admission; n(%)b | 87 (36.7) | 106 (24.9) | 11.8 (4.4–19.2) |
Admission | |||
Length of stay; days (IQR)a | 7 (4–10) | 6 (3–9) | 1(÷1–0) |
Atrial fibrillation | |||
None, n(%)a | 175 (73.8) | 323 (76.0) | 2.2(÷9.1–4.7) |
New-onset atrial fibrillation; n(%)a | 9 (3.8) | 23 (5.4) | 1.6(÷4.8–1.7) |
History of atrial fibrillation; n(%)a | 53 (22.4) | 79 (18.6) | 3.8(÷2.7–10.3) |
Severity of disease | |||
Total SOFA score (IQR)a | 3 (2–4) | 3 (2–3) | 0 |
Systolic blood pressure; mmHg, median (IQR)a,h | 122 (105–144) | 126 (109–147) | 3(÷1–8) |
Systolic blood pressure < 90 mmHg, n(%)a | 13 (5.6) | 20 (4.8) | 0.8(÷2.8–4.4) |
Respiratory rate; min−1, median (IQR)a | 20 (17–24) | 20 (18–24) | 0 |
Heart rate; min−1, median (IQR)a | 90 (80–105) | 93 (77–109) | 2(÷2–5) |
O2-Saturation; %, median (IQR)a | 95 (92–97) | 95 (93–97) | 0 |
Core temperature; oCelcius, median (IQR)a,i | 37.2 (36.6–38.0) | 37.4 (36.7–38.4) | 0.2 (0–0.4) |
Altered mental state; n (%)a | 62 (26.2) | 117 (27.5) | 1.3(÷8.3–5.7) |
qSOFA score ≥ 2 on admission; n(%)a | 48 (20.3) | 78 (18.4) | 1.9(÷4.4–8.2) |
SIRS criteria ≥2 on admission, n(%)a | 131 (55.3) | 263 (61.9) | 6.6(÷1.2–14.4) |
Laboratory results | |||
CRP; median (IQR)b | 65 (23–123) | 82 (24–160) | 10.9 (1.0–21.9) |
White blood cell count ×109/L, median (IQR)a | 12.1 (8.9–16.1) | 11.6 (8.6–16.6) | 0.1(÷1.0–0.8) |
Creatinine, μmol/L, median (IQR)a | 115 (80–178) | 113 (75–168) | 5.0(÷15.0–4.0) |
Bilirubin, mmol/L, median (IQR)a | 10 (7–16) | 10 (7–18) | 1 (0–2) |
Platelets, ×109/L, median (IQR)a | 216 (153–288) | 205 (144–283) | 10(÷26–5) |
Lactate; mmol/L, median (IQR)a,j | 1.2 (0.8–2.0) | 1.3 (0.9–2.1) | 0.1(÷0.1–0.2) |
Glucose, mmol/L, median (IQR)b | 6.8 (5.9–8.2) | 7.3 (6.0–8.9) | 0.4 (0.1–0.7) |
Admission to intensive care unit, n (%)a | 24 (10.1) | 56 (13.2) | 3.1(÷8.1–1.9) |
Vasopressor, n (%)b | 1 (0.4) | 10 (2.4) | 2.0 (0.3–3.7) |
Mechanical ventilation, n (%)a | 8 (3.4) | 23 (5.4) | 2.0(÷1.2–5.2) |
Dialysis, n (%)a | 1 (0.4) | 2 (0.5) | 0.1(÷1.1–0.9) |
Positive blood cultures, n (%)a,k | 18 (12.6) | 38 (14.1) | 1.5(÷6.8–3.9) |
Source of infection | |||
Pulmonary, n (%)a | 137 (57.8) | 252 (59.3) | 1.5(÷9.3–6.3) |
Urine, n (%)a | 47 (19.8) | 101 (23.8) | 4.0(÷10.5–2.5) |
Abdominal, n (%)a | 26 (11.0) | 40 (9.4) | 1.6(÷3.3–6.5) |
Skin, n(%)a | 19 (8.0) | 26 (6.1) | 1.9(÷2.2–6.0) |
Endocarditis, n(%)a | 1 (0.4) | 1 (0.2) | 0.2(÷0.7–1.1) |
Central nervous system, n (%)a | 1 (0.4) | 3 (0.7) | 0.3(÷1.4–0.8) |
Facial/teeth, n(%)a | 1 (0.4) | 1 (0.2) | 1.9(÷2.2–6.0) |
Devices/implants | 0 | 0 | – |
Others, n(%)a | 3 (1.3) | 0 | 1.3(÷0.1–2.7) |
Unknown, n(%)a | 19 (8.0) | 35 (8.2) | 0.2(÷4.5–4.1) |
> 1 focus, n(%)a | 18 (7.6) | 33 (7.8) | 0.2(÷4.4–4.0) |
Medication, N(%) | Readmitted N = 237 (35.8%) | Not readmitted N = 425 (64.2%) | Difference (95% CI) |
---|---|---|---|
Cardiac | |||
Beta-blockersa | 75 (31.7) | 112 (26.4) | 5.3(÷2.0–12.6) |
Calcium antagonistsa | 42 (17.7) | 90 (21.2) | 3.5(÷9.7–2.7) |
Digoxina | 14 (5.9) | 15 (3.5) | 2.4(÷1.1–5.9) |
ACE-inhibitors/AII-antagonistsa | 82 (34.6) | 137 (32.2) | 2.4(÷5.1–9.9) |
Anticoagulantsb,c | 126 (53.2) | 190 (44.7) | 8.5 (0.6–16.4) |
Diureticsb | 126 (53.2) | 167 (39.3) | 13.9 (6.0–21.8) |
Lipid lowering drugsa | 79 (33.3) | 119 (28.0) | 5.3(÷2.0–12.7) |
Pulmonary | |||
Inhalation medicationsa | 58 (24.5) | 89 (20.9) | 3.6(÷3.1–10.3) |
Diabetes | |||
Insulin/peroral antidiabeticsa | 42 (17.7) | 74 (17.4) | 0.3(÷5.7–6.3) |
Psychopharmacology medicationa,d | 42 (17.7) | 75 (17.7) | 0 |
Analgesic | |||
Opioidsb | 51 (21.5) | 62 (14.6) | 6.9 (0.7–13.1) |
Other analgesicsa,e | 78 (32.9) | 147 (34.4) | 1.5(÷9.0–6.0) |
Mortality
Predictors for readmission
Unadjusted subhazard ratio | Adjusted subhazard ratio (full model)a (95% CI) | Adjusted subhazard ratio (final model) (95% CI) | |
---|---|---|---|
Ageb | 1.00 (0.99–1.01) | 0.99 (0.98–1.00) | – |
Female gender | 1.02 (0.79–1.32) | 1.06 (0.81–1.38) | – |
COPD | 1.24 (0.93–1.66) | 1.16 (0.88–1.55) | – |
Diabetes | 1.12 (0.84–1.51) | 1.09 (0.77–1.52) | – |
Kidney disease | 1.27 (0.83–1.94) | 1.13 (0.74–1.70) | – |
C-reactive proteinb | 0.998 (0.997–1.000) | 1.00 (1.00–1.00) | – |
Glucoseb | 0.99 (0.95–1.02) | 0.98 (0.94–1.02) | – |
Anticoagulant treatment | 1.31 (1.01–1.68) | 1.21 (0.91–1.61) | – |
Vasopressor treatment | 0.22 (0.03–1.72) | 0.19 (0.02–1.58) | – |
Opioid treatment | 1.43 (1.05–1.94) | 1.22 (0.90–1.67) | – |
Malignant disease | 1.70 (1.24–2.34) | 1.68 (1.20–2.33) | 1.61 (1.16–2.23) |
Previous admitted with sepsis | 1.51 (1.17–1.97) | 1.28 (0.97–1.67) | 1.41 (1.08–1.84) |
Treatment with diuretics | 1.53 (1.18–1.98) | 1.48 (1.12–1.95) | 1.51 (1.17–1.94) |