Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data.
Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data.
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DOI：
10.1186/s12889-021-11481-6
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发表时间：
2021-07-29
影响因子：
4.5
通讯作者：
TRACT trial group
中科院分区：
文献类型：
--
作者：
Connon R;George EC;Olupot-Olupot P;Kiguli S;Chagaluka G;Alaroker F;Opoka RO;Mpoya A;Walsh K;Engoru C;Nteziyaremye J;Mallewa M;Kennedy N;Nakuya M;Namayanja C;Nabawanuka E;Sennyondo T;Amorut D;Williams Musika C;Bates I;Boele van Hensbroek M;Evans JA;Uyoga S;Williams TN;Frost G;Gibb DM;Maitland K;Walker AS;TRACT trial group
严重贫血（血红蛋白<6 g/dL）是非洲儿童反复住院的主要原因。我们研究了TRACT试验（ISRCTN84086586）中严重贫血住院儿童再入院的预测因素，以确定未来可能的干预措施。该试验的次要分析检查了来自乌干达和马拉维的3894名儿童，这些儿童在医院发生严重贫血后幸存下来。出院后180天内全因再入院的预测因素采用多变量回归分析，死亡作为竞争风险。具有相似特征的儿童组采用分层聚类进行识别。在3894例存活者中，682例（18%）再次入院; 403例（10%）在180天内再次入院≥ 2次。确定了三个主要的再入院原因：严重贫血（n = 456），疟疾（n = 252）和血红蛋白尿/黑尿综合征（n = 165）。总体而言，增加再入院风险的因素包括艾滋病毒感染（风险比2.48（95% CI 1.63 - 3.78），p <0.001）;前12个月内住院≥ 2次（1.44（1.19 - 1.74），p <0.001）;输血史（1.48（1.13 - 1.93），p = 0.005）;和缺失≥ 1次试验药物剂量（代表护理质量）（1.43（1.21 - 1.69），p <0.001）。在初次入院期间从未接受输血（根据试验方案）的无并发症重度贫血（Hb 4 - 6 g/dL，无严重程度特征）儿童的再入院风险显著降低（0.67（0.47 - 0.96），p = 0.04）。疟疾（在既往无输血史的儿童中）（0.60（0.47 - 0.76），p <0.001）;高龄（每年轻1岁1.07（1.03 - 1.10），p <0.001）和已知的镰状细胞病（0.62（0.46 - 0.82），p = 0.001）也降低了再入院的风险。对于贫血再入院，与无脾肿大相比，肉眼脾肿大和脾肿大分别增加1.73（1.23 - 2.44）和1.46（1.18 - 1.82）的风险。聚类确定了四组儿童的再入院率从14%到20%。具有最高再入院率的集群的特征在于非常低的血红蛋白（平均3.6 g/dL）。镰状细胞病（SCD）在与慢性反复入院或严重急性表现在很大程度上未确诊的SCD相关的两个集群中占主导地位。最后一组的疟疾发病率高（78%），症状严重，血小板计数极低，与急性重症疟疾一致。年轻、HIV感染和既往住院史预示着再入院风险增加。然而，没有明确的临床干预因素。由于药物剂量缺失具有高度预测性，因此关注护理相关因素可能很重要。ISRCTN ISRCTN 84086586。在线版本包含补充材料，可通过10.1186/s12889 - 021 - 11481 - 6获得。
Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63–3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19–1.74), p < 0.001); history of transfusion (1.48(1.13–1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21–1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47–0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47–0.76), p < 0.001); younger-age (1.07 (1.03–1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46–0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23–2.44) and 1.46(1.18–1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. ISRCTN ISRCTN84086586. The online version contains supplementary material available at 10.1186/s12889-021-11481-6.
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DOI：
10.1056/nejmoa1900105
发表时间：
2019-08-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Maitland K;Kiguli S;Olupot-Olupot P;Engoru C;Mallewa M;Saramago Goncalves P;Opoka RO;Mpoya A;Alaroker F;Nteziyaremye J;Chagaluka G;Kennedy N;Nabawanuka E;Nakuya M;Namayanja C;Uyoga S;Kyeyune Byabazaire D;M'baya B;Wabwire B;Frost G;Bates I;Evans JA;Williams TN;George EC;Gibb DM;Walker AS;TRACT Group
通讯作者：
TRACT Group
影响因子：
3
作者：
Bisoffi, Zeno;Leoni, Stefania;Buonfrate, Dora
通讯作者：
Buonfrate, Dora
影响因子：
9.3
作者：
Kiguli S;Maitland K;George EC;Olupot-Olupot P;Opoka RO;Engoru C;Akech SO;Nyeko R;Mtove G;Reyburn H;Levin M;Babiker AG;Gibb DM;Crawley J
通讯作者：
Crawley J
影响因子：
158.5
作者：
Calis, Job C. J.;Phiri, Kamija S.;van Hensbroek, Michael Boele
通讯作者：
van Hensbroek, Michael Boele
影响因子：
168.9
作者：
Dondorp, Arjen M.;Fanello, Caterina I.;White, Nicholas J.
通讯作者：
White, Nicholas J.