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. 

In This Article


Rate and Reasons for 30-day Readmissions in Hospitalizations With Adrenal Insufficiency

During the study period 7738 index hospitalizations were identified as patients with AI who met the inclusion criteria. Of these hospitalizations, 7691 were discharged alive. The 30-day all-cause readmission rate for AI was 17.3%. Figure 1 shows the Kaplan-Meier curve for 30-day all-cause readmission in this population. About 1 in 5 readmissions was for AI (19.7%). Other reasons for readmission included sepsis from unspecified organism (10.8%), unspecified pneumonia (3.1%), acute renal failure unspecified (1.6%), hypertensive heart and CKD with heart failure, which is defined as hypertensive heart with stage 5 CKD or end-stage renal disease (1.5%), hypertensive heart disease with heart failure (1.3%), urinary tract infection from an unspecified site (1.2%), other pulmonary embolism without acute cor pulmonale (1.1%), type 2 diabetes mellitus with hypoglycaemia without coma (1.1%) and chronic obstructive pulmonary disease with acute exacerbation (1.1%) (Table 1).

Figure 1.

Kaplan-Meier graph for 30-day all-cause readmissions of adrenal insufficiency hospitalizations [Colour figure can be viewed at]

Comparing Patients and Hospital Characteristics of Index Admissions and Readmissions

There was no significant difference in mean age (58.2 vs. 59.1 years, p = .156) and sex distribution between the index admissions and readmissions. However, readmissions were more likely to have Charlson Comorbidity (CCI) score >2 (51.1% vs. 33.9%) and Medicaid as the main insurer (68.5% vs. 57.3%). Readmissions also had higher proportion of comorbid congestive heart failure (22.1% vs. 15.5%, p < .001), CKD (26.2% vs. 22.0%, p = .011) and protein-energy malnutrition (15.7% vs. 11.8%, p = .003), but a lower proportion of hypertension compared with the index admissions (Table 2).

Comparing Outcomes in Index Admissions and Readmissions

Readmission following AI was associated with significantly higher odds of inpatient mortality (4.3% vs. 0.6%, odds ratio (OR): 7.88, 95% CI: 4.46–13.93, p < .001) compared with index admissions. Readmission was also associated with increased mean length of stay (LOS) (5.7 vs. 4.7 days, OR: 1.0, 95% CI: 0.6–1.4 days, p < .001), higher total hospital charges (THCs) ($41,477 vs. $59,012; OR: 17,535; 95% CI: 11,119–23,952; p < .001) and cost of hospitalizations (COH) ($10,326 vs. $13,814; 95% CI: 2126–4849; p < .001) (Table 3).

Predictors of 30-day All-cause Readmissions of Adrenal Insufficiency Hospitalizations

Older age was associated with slightly lower hazard ratio for readmission (0.99) when adjusted for other factors including disease severity and protein-energy malnutrition. Independent predictors of 30-day all-cause readmissions of AI included index hospitalizations with CCI ≥3 (aHR: 2.53, 95% CI: 1.85–3.46, p < .001), being discharged against medical advice (aHR: 1.78, 95% CI: 1.09–2.91, p = .021), protein-energy malnutrition (aHR: 1.28, 95% CI: 1.02–1.60, p = .035) and obesity (aHR: 1.26, 95% CI: 1.02–1.56, p = .035) shown in Table 4.