Frequency and Cause of Readmissions in Sepsis Patients Presenting to a Tertiary Care Hospital in a Low Middle Income Country

Hospital readmissions are known to be common after sepsis but unfortunately, in a developing country like Pakistan, very little is known of the frequency or cause of these readmissions in sepsis patients and even less about how they can be prevented. To our knowledge, this is the first-ever long-term follow-up study in a developing country in which frequency and cause of readmissions are being evaluated in sepsis patients. DESIGN: This retrospective study evaluated sepsis patients admitted at the Aga Khan University Hospital in 2017. Outcome measures included in-hospital mortality and readmission within 180 days. SETTING: Aga Khan University Hospital, Karachi, Pakistan. SUBJECTS: Four-hundred thirty-nine sepsis patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Respiratory infections were the most common cause of sepsis (172 [39%]) followed by urinary tract infections (86 [20%]). Mortality in sepsis was 42% (183/439) and associated risk factors included ICU admission (odds ratio, 1.57; 95% CI, 1.05–2.35; p = 0.027), malignancy(odds ratio, 3.50; 95% CI, 1.70–7.19; p = 0.001), acute kidney injury (odds ratio, 1.86; 95% CI, 1.25–2.77; p = 0.002), septic shock (odds ratio, 4.75; 95% CI, 3.04–7.35; p = 0.001), and serum lactate greater than or equal to 4 mmol (odds ratio, 5.11; 95% CI, 3.00–8.73; p = 0.001). Of the 256 patients that survived, 31% (79/256) were readmitted within 180 days. Infections accounted for 67% (53/79) of these readmissions. Half of these infections were new infections while an additional 26% were unclear since cultures were negative in at least one of the hospitalizations. CONCLUSIONS: We concluded that mortality rates in sepsis are alarmingly high and even those who manage to survive are still at a great risk of getting readmitted due to a new infection in the near future. Given the limited resources available in developing countries, prevention of these infections should be given utmost importance. Unfortunately, reliable interventions to identify high-risk patients for readmissions are still inadequately characterized. Hence, we hope this study becomes a platform for larger multicenter studies in developing countries for early prediction of potential readmissions and developing precise interventions to prevent them.