Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (1): 123-127     DOI: 10.31083/j.rcm.2020.01.552 Predictors of 30-day re-admissions in patients with infective endocarditis: a national population based cohort study Akanksha Agrawal1, *(), Hafeez Ul Hassan Virk2, Iqra Riaz2, Deepanshu Jain3, Byomesh Tripathi4, Chayakrit Krittanawong5, Benham Bozorgnia2, Vincent Figueredo6, Peter A. McCullough5, Janani Rangaswami7, 8 1 Division of Cardiology, Department of Internal Medicine, Emory University, Atlanta, GA 30322, USA
2 Division of Cardiology, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA 19141, USA
3 Center for Interventional Endoscopy, AdventHealth Orlando, FL 32803, USA
4 Department of Cardiology, Geisinger Medical Center, Danville, PA 17822, USA
5 Division of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Baylor Heart and Vascular Institute, TX 75226, USA
6 Division of Cardiology, Saint Mary's Medical Center, PA 19047, USA
7 Division of Nephrology, Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA 19141, USA
8 Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA 19107, USA Abstract:

Infective endocarditis (IE) is a life threatening disease requiring lengthy hospitalizations, complex multidisciplinary management and high health care costs. In this study, we analyzed the National Readmissions' Database (NRD) to identify infective endocarditis cases and the causative organisms, clinical determinants, length of stay, in-hospital mortality, and 30-day hospital readmission rates. The study cohort was derived from Healthcare Cost and Utilization Project's National Readmission Database between 2010-15. We queried the National Readmissions' Database using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic code for infective endocarditis (421.0) and identified a total of 187,438 index admissions. SAS 9.4 (SAS Institute Inc., Cary, NC) was utilized for statistical analyses. A total of 187,438 patients with a primary diagnosis of IE were identified over 6 years (2010-2015). Twenty-four percent (44,151 patients) were readmitted within 30 days. Most common etiologies for readmission included sepsis (14%), acute heart failure (8%), acute kidney injury (6%), intracardiac device infection (5.6%) and recurrence of IE (2.7%). Predictors of increased readmissions included female sex, staphylococcus aureus infection, diabetes, chronic lung disease, chronic liver disease, acute kidney injury, acute heart failure and anemia. In-hospital mortality for the readmission of IE was 13%, and average length of stay during the re-admission was 12 days. IE is associated with high rates of index admission mortality and for 30-day readmissions of which are associated with a substantial risk of death.

Submitted:  21 August 2019      Accepted:  17 March 2020      Published:  30 March 2020      *Corresponding Author(s):  Akanksha Agrawal     E-mail:  aagra30@emory.edu Service E-mail this article Add to citation manager E-mail Alert RSS Articles by authors Akanksha Agrawal    Hafeez Ul Hassan Virk    Iqra Riaz    Deepanshu Jain    Byomesh Tripathi    Chayakrit Krittanawong    Benham Bozorgnia    Vincent Figueredo    Peter A. McCullough    Janani Rangaswami    Cite this article: 

Akanksha Agrawal, Hafeez Ul Hassan Virk, Iqra Riaz, Deepanshu Jain, Byomesh Tripathi, Chayakrit Krittanawong, Benham Bozorgnia, Vincent Figueredo, Peter A. McCullough, Janani Rangaswami. Predictors of 30-day re-admissions in patients with infective endocarditis: a national population based cohort study. Reviews in Cardiovascular Medicine, 2020, 21(1): 123-127.

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https://rcm.imrpress.com/EN/10.31083/j.rcm.2020.01.552     OR     https://rcm.imrpress.com/EN/Y2020/V21/I1/123

Figure 1.  Figure depicting various etiologies for 30-day readmission after an index admission for infective endocarditis with their respective percentages. Sepsis was the most common cause of readmission with about 14% of total readmissions.

Table 1.  Multivariate predictors of 30-day re-admission after the index admission for infective endocarditis.

VariableOdds Ratio95% Confidence IntervalP- valueAge0.9980.996-0.999< 0.001Female1.0611.024-1.0990.001Type of infectionStaphylococcus aureus1.0631.021-1.1070.003Streptococcal endocarditis0.9940.952-1.0380.790Gram negative endocarditis1.1001.023-1.1830.010ComorbiditiesObesity1.0030.951-1.0580.909Hypertension1.0180.979-1.0600.366Diabetes1.1191.076-1.163< 0.001Chronic lung disease1.1601.112-1.210< 0.001Chronic Liver disease1.1631.096-1.234< 0.001Renal Failure1.3171.265- 1.372< 0.001Anemia1.0991.061-1.139< 0.001Rheumatological disorder1.0981.007-1.1970.034Heart failure1.1721.123-1.225< 0.001Private including HMO0.8650.825< 0.001Self-pay/no charge/other0.7870.736< 0.001Disposition to Facility/others1.0991.060< 0.001Length of stay1.0000.9990.568

Table 2.  Studies describing the readmission rate for patients with infective endocarditis.

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