Early Readmissions After Hospitalization for Posterior Reversible Encephalopathy Syndrome

Abstract

Objective:To evaluate the frequency, etiologies, and risk factors for 90-day readmissions following hospitalization for PRES.Methods:Data were obtained from the Nationwide Readmissions Database 2016-2018. Patients with primary diagnosis of PRES, survival to discharge, and known discharge disposition were included. Primary outcome was non-elective readmission within 90 days of discharge. Survival analysis was performed, and independent predictors of readmission were analyzed using multivariable Cox proportional hazards regression.Results:Based on the study inclusion criteria, 6,155 eligible patients were included (mean±SD age: 55.9±17.3 years, female: 71.0%). Non-elective readmission within 90 days of discharge occurred for 1,922 (31.2%) patients. Of these, 617 readmissions were due to PRES-related or neurological etiologies and the remaining 1305 readmissions were due to non-neurological conditions. In multivariable analysis, age was inversely associated with risk of readmission [hazards ratio (HR): 0.92 for every 10 years increase in age, 95% confidence interval (CI): 0.88-0.97]. Patients with diabetes (HR: 1.21, 95% CI: 1.04-1.42), systemic lupus erythematosus (HR: 1.42, 95% CI: 1.03-1.96), acute kidney injury (HR: 1.28, 95% CI: 1.11-1.47) and higher Charlson comorbidity index score (HR: 1.09, 95% CI: 1.06-1.13) were more likely to be readmitted. Further, patients admitted at large bed size hospitals (HR: 1.19, 95% CI: 1.03-1.39), those with longer length of stay (HR: 1.01, 95% CI: 1.00-1.02) and those not discharged to home (HR: 1.33, 95% CI: 1.14-1.55) during the index hospitalization were also at a higher risk for readmission.Conclusion:Nearly one-third of patients hospitalized due to PRES are readmitted within 90 days of discharge and about one-third of these readmissions are due to PRES-related or neurological etiologies. Younger age, a higher comorbidity burden, longer length of hospital stay, and discharge disposition other than to home are independently associated with the risk of readmission.