Predictors of 30-Day Readmissions for Adrenal Insufficiency

A Retrospective National Database Study

Asim Kichloo; Zain El-amir; Hafeez Shaka; Farah Wani; Sofia Junaid Syed

Clin Endocrinol. 2021;95(2):269-276.

Conclusions

Adrenal insufficiency, a condition marked by deficiency in glucocorticoid production along the HPA axis, is a potentially deadly disease that can result in numerous hospital admissions. In a national readmission database, 17.3% of hospitalizations resulted in 30-day readmission, with the most common cause of readmission being AI. Readmissions were associated with increased mortality, longer mean LOS, higher THC and higher COH. Independent predictors of readmission were CCI of 3 or greater, being discharged against medical advice, protein-energy malnutrition and obesity. Based on the results of this study, we strongly believe that patients hospitalized with AI and the aforementioned predictors of readmission are at higher risk of readmission, which is associated with further complications, greater financial burden and death. Hence, aggressive yet appropriate monitoring should be considered for these hospitalized patients.

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Acknowledgements
None.

Ethical Approval
Our institution does not require ethical approval NIS database studies.

Table 1. Top 10 principal diagnoses of readmissions for adrenal insufficiency hospitalizations
Principal readmission diagnosis n = 1352	Proportion, %
Adrenal insufficiency	19.7
Sepsis, unspecified organism	10.8
Unspecified pneumonia	3.1
Unspecified acute renal failure	1.6
Hypertensive heart and CKD with heart failure	1.5
Hypertensive heart disease with heart failure	1.3
Urinary tract infection, unspecified site	1.2
Other pulmonary embolism without acute cor pulmonale	1.1
Type 2 diabetes mellitus with hypoglycaemia without coma	1.1
Chronic obstructive pulmonary disease with (acute) exacerbation	1.1

Table 2. Patient and hospital characteristics of hospitalizations with adrenal insufficiency
Variable	Index admission, %	30-day readmission, %	p value
Variable	n = 7738	n = 1352	p value
Patient characteristics
Age, mean years	58.2 ± 0.7	59.1 ± 1.3	.156
Women	59.4	58.4	.597
Charlson Comorbidity Index score			<.001
0	27.9	15.1
1	20.8	17.5
2	17.4	16.3
≥3	33.9	51.1
Insurance type			<.001
Medicaid	57.3	68.5
Medicare	15.3	16.9
Private	24.4	16.7
Uninsured	3.0	1.9
Median annual income in patient's zip code, US$^#			.135
1–45,999	27.1	30.4
46,000–58,999	28.3	29.2
59,000–78,999	25.1	23.2
≥79,000	19.5	17.2
Comorbidities
Diabetes	29.0	29.0	.998
Hypertension	29.2	25.3	.040
Smoking history	13.3	14.3	.480
CHF	15.5	22.1	<.001
CKD	22.0	26.2	.011
Obesity	15.0	17.6	.060
Dyslipidaemia	31.1	31.5	.850
CAD	18.7	25.2	<.001
Prior CVA	1.9	2.5	.255
Malnutrition	11.8	15.7	.003
COPD	15.5	20.3	<.001
History of neoplasm	18.7	24.4	<.001
Hospital characteristics
Hospital bed size			.557
Small	15.9	14.9
Medium	26.1	24.9
Large	58.0	60.2
Metropolitan location	80.9	79.7	.444
Teaching hospital	72.7	71.0	.333

Abbreviations: CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CVA, cerebrovascular accident.
^#For 2018.

Table 3. Clinical outcomes in hospitalizations with adrenal insufficiency
Outcome	Index admission, %	30-day readmission, %	OR (95% CI)	p value*
In-hospital mortality	0.56	4.28	7.88 (4.46–13.93)	<.001*
Length of stay, mean	4.7	5.7	1.0^# (0.6–1.4)	<.001*
Total hospital charges, mean US$	41,477	59,012	17,535^# (11,119–23,952)	<.001*
Total hospital cost, mean US$	10,326	13,814	3488^# (2126–4849)	<.001*

Abbreviations: CI, confidence interval; OR, odds ratio.
*Statistically significant,
^#mean difference.

Table 4. Independent predictors of 30-day all-cause readmissions of adrenal insufficiency hospitalizations
Variable	aHR	95% confidence Interval	p value*
Charlson index of ≥3	2.53	1.85–3.46	<.001*
Against medical advice	1.78	1.09–2.91	.021*
Charlson index of 2	1.54	1.15–2.08	.004*
Protein-energy malnutrition	1.28	1.02–1.60	.035*
Obesity	1.26	1.02–1.56	.035*
History of neoplasm	1.12	0.89–1.40	.325
COPD	1.04	0.86–1.27	.666
Age	0.99	0.996–0.999	.019*
Diabetes	0.94	0.79–1.13	.522
Hypertension	0.86	0.69–1.06	.150
Chronic kidney disease	0.86	0.67–1.09	.204
Private insurance^#	0.64	0.49–0.83	.001*

Abbreviation: aOR, adjusted hazard ratio.
*Statistically significant,
^#relative to Medicaid.

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Predictors of 30-Day Readmissions for Adrenal Insufficiency

A Retrospective National Database Study

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