Association between age-adjusted Charlson Comorbidity Index and risk of nonhome discharge in sepsis survivors: A retrospective analysis based on the Medical Information Mart for Intensive Care IV database.

Abstract

Background: Sepsis is a common complication in intensive care units, and the discharge disposition of survivors has clinical significance. The Charlson Comorbidity Index (CCI) predicts long-term outcomes based on comorbidity burden.

Purpose: To investigate the association between age-adjusted CCI (ACCI) and nonhome discharge among sepsis survivors.

Methodology: A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care IV database. Adult sepsis survivors (Sepsis-3.0 criteria) were included. Patients who died during hospitalization or had missing data were excluded. The primary outcome was nonhome discharge (i.e., discharge to skilled nursing facilities, long-term care, or rehabilitation). Multivariable logistic regression, subgroup, and sensitivity analyses were performed.

Results: Among 23,683 sepsis survivors, 44.9% were discharged home, and 55.1% had nonhome discharge. In the nonhome discharge group, 65% had a CCI score ≥5, compared with 40.4% in the home discharge group. Multivariable logistic regression showed that each 1-point increase in ACCI was associated with higher odds of nonhome discharge (odds ratio = 1.15, 95% confidence interval: 1.14-1.16, p < .001). This association remained robust across sensitivity analyses.

Conclusions: An ACCI means people with sepsis are more likely to be discharged to a location other than home.

Implications: The ACCI can help nurses figure out which patients with sepsis are at risk. This can help plan for their care after they leave the hospital, and it can also help make sure that the right resources are used for the patients.