Stephanie Parks Taylor1,2, Bethany C Bray3, Shih-Hsiung Chou4, Ryan Burns4, Marc A Kowalkowski4. 1. Department of Internal Medicine, Wake Forest School of Medicine Atrium Health Enterprise, Charlotte, North Carolina. 2. Critical Illness Injury and Recovery Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina. 3. Center for Dissemination and Implementation Science, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois; and. 4. Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina.
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.
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.
Authors: Hallie C Prescott; Carolyn S Calfee; B Taylor Thompson; Derek C Angus; Vincent X Liu Journal: Am J Respir Crit Care Med Date: 2016-07-15 Impact factor: 21.405
Authors: Hallie C Prescott; Theodore J Iwashyna; Bronagh Blackwood; Thierry Calandra; Linda L Chlan; Karen Choong; Bronwen Connolly; Paul Dark; Luigi Ferrucci; Simon Finfer; Timothy D Girard; Carol Hodgson; Ramona O Hopkins; Catherine L Hough; James C Jackson; Flavia R Machado; John C Marshall; Cheryl Misak; Dale M Needham; Pinaki Panigrahi; Konrad Reinhart; Sachin Yende; Ross Zafonte; Kathryn M Rowan; Derek C Angus Journal: Am J Respir Crit Care Med Date: 2019-10-15 Impact factor: 21.405
Authors: Stephanie Parks Taylor; Stephanie Murphy; Aleta Rios; Andrew McWilliams; Lewis McCurdy; Shih-Hsiung Chou; Timothy Hetherington; Whitney Rossman; Mark Russo; Michael Gibbs; Marc A Kowalkowski Journal: Crit Care Med Date: 2022-03-01 Impact factor: 7.598
Authors: Hallie C Prescott; Kenneth M Langa; Vincent Liu; Gabriel J Escobar; Theodore J Iwashyna Journal: Am J Respir Crit Care Med Date: 2014-07-01 Impact factor: 30.528