Hospital readmission after surviving sepsis: An analysis of infection recurrence, risk factors and long-term survival

Hospital readmission after sepsis poses a substantial burden on the healthcare system. The aim of this study was to characterize hospital readmissions after sepsis in terms of risk factors, underlying causes, readmission timing and long-term outcome after readmission. We included patients from the Acutelines data- and biobank who were hospitalized with sepsis. The primary outcome was acute all-cause hospital readmission, with infection-related hospital readmission as secondary outcome. Among 851 patients with sepsis, 219 (26%) were readmitted within 90 days. 67% was readmitted due to an infectious reason. In 70% of cases, this infection was at the same site as the initial infection, and in 50% of the cases, it was also the same type of pathogen. Viral sepsis was associated with a higher risk of readmission than bacterial during the first month after discharge; after this time-point, the readmission risk after viral sepsis declined, while the risk after bacterial sepsis remained high. Risk factors associated with all-cause hospital readmission were malignancy, the use of immunosuppressants, the use of analgesics, and a higher SOFA score during admission, whereas haemoglobin at triage and sepsis due to SARS-CoV-2 were associated with lower risk for all-cause readmission. History of an organ transplantation and a bacterial and viral co-infection were associated with infection-related hospital readmission. Patients who were readmitted had higher long-term mortality rates than patients who were not readmitted. In conclusion, efforts to reduce readmission should focus on preventing infections, particularly in patients who are immunocompromised due to either comorbidities or medication use. • 1 in 4 sepsis survivors was readmitted within 90 days; most were infection-related. • 50% of the time, site and pathogen type were the same as the index sepsis. • Immunosuppression was a key risk factor for readmission after sepsis. • Viral sepsis showed early readmission and bacterial sepsis a sustained risk. • Readmission was associated with an increased risk for long-term mortality.