Index Severity Score and Early Readmission Predicts Increased Mortality in Ulcerative Colitis Patients

Kruger AJ1, Hinton A2, Afzali A3,4. Inflamm Bowel Dis. 2018 Sep 20. doi: 10.1093/ibd/izy297. [Epub ahead of print]

Author information

1 Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.

2 Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio.

3 Inflammatory Bowel Disease Center at The Ohio State University Wexner Medical Center, Columbus, Ohio.

4 Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio.


BACKGROUND: Readmissions are common after hospitalization related to ulcerative colitis (UC). A risk score to stratify the severity of UC hospitalizations and risk of colectomy has been previously reported. Our aim was to predict hospital-related outcomes after hospitalizations for UC utilizing this severity score.

METHODS: We utilized the Nationwide Readmissions Database (2010-2014) for hospitalized patients with UC and differentiated patients by index severity (low, intermediate, high). Baseline characteristics, surgical rates, readmissions, mortality, and hospital outcomes were collected. The primary outcomes of interest included readmission and mortality rates.

RESULTS: There were 133,819 patients admitted with UC with 22,762 (17%) readmitted within 30 days. Those readmitted within 30 days had a 4.5% calendar year mortality rate, compared with 0.45% in those not readmitted within 30 days (P < 0.001). Index surgery rates (19.2% vs 12.3%), length of stay (6.9 vs 5.4 days), and hospital costs ($13,530 vs $10,366; P < 0.001 for all) were higher in those readmitted within 30 days. Patients with high-severity presentations had higher surgical rates (31.6%), higher 30-day and calendar year readmission rates (24.3% and 46.0%, respectively), increased index and calendar year mortality (2.5% and 2.0%, respectively), longer length of stay (15.1 days), and increased costs ($31,136) compared with those with low severity (P < 0.001 for all). Calendar-year survival rates in those with intermediate and high scores were significantly lower than in those with low scores.

CONCLUSIONS: An index severity score of intermediate or high and early readmissions are predictors of calendar year mortality. Future efforts should emphasize more focused care in high-risk patients, as this may reduce readmissions and improve outcomes.

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