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TOPLINE:

Patients discharged from the emergency department (ED) with common infections had a higher 7-day sepsis risk if they had cardiovascular disease, hypertension, chronic kidney disease, or cancer; arrived by ambulance; or presented with tachycardia or fever, whereas hyperlipidemia appeared to be protective, according to a cohort study.

METHODOLOGY:

• Researchers conducted a retrospective cohort analysis of 10,179 adults discharged from the ED at their index visit with a diagnosis at discharge of pneumonia, urinary tract infection, or cellulitis.
• The primary outcome was sepsis-related hospital readmission within 7 days of the index ED visit.
• Researchers compared patient characteristics between patients who returned to the hospital within 7 days of the index ED visit for sepsis and those who did not.
• Variables included comorbidities involving cardiovascular risk factors, including hypertension and cardiovascular disease; chronic medical conditions such as chronic kidney disease and cancer; demographic characteristics; proxy for social determinants of health; and vital signs.

TAKEAWAY:

• Overall, 113 patients had a sepsis-related readmission within 7 days; they were older (57.2 vs 52 years), more often men (59.3% vs 43.1%), and more likely to arrive by ambulance (39.8% vs 21.7%) than the 9831 patients who did not return for a readmission.
• Cardiovascular disease (odds ratio [OR], 2.07; 95% CI, 1.26-3.42), hypertension (OR, 2.21; 95% CI, 1.37-3.56), chronic kidney disease (OR, 1.80; 95% CI, 1.11-2.91), and cancer (OR, 2.22; 95% CI, 1.43-3.45) were identified as significant risk factors.
• Men had 1.67 times the odds of sepsis-related admission compared with women. Arriving by ambulance vs walk-in (OR, 2.55; 95% CI, 1.46-4.44), each 10-beats/min rise in heart rate (OR, 1.29; 95% CI, 1.16-1.45), and each °F increase in body temperature (OR, 1.23; 95% CI, 1.05-1.45) raised the odds of readmission, whereas hyperlipidemia had a protective effect (OR, 0.56; 95% CI, 0.34-0.91).
• The model distinguished sepsis readmission cases with good accuracy (c-statistic = 0.77) and fit the observed data well (Hosmer-Lemeshow P = .51).

IN PRACTICE:

"We identified risk factors that can be used to predict sepsis-related admission for patients who were initially discharged from the ED with pneumonia, UTI [urinary tract infection], and/or cellulitis. Our findings may be used to risk-stratify and guide outpatient disposition decisions for ED patients with infection and determine which patients need to be more closely monitored in the outpatient setting following ED discharge," the authors wrote.

SOURCE:

The study was led by Alice Chen, MD, MPH, University of California San Diego. It was published online on August 07, 2025, in The American Journal of Emergency Medicine.

LIMITATIONS:

The generalizability of the findings was limited by the study's focus on two medical centers within the same health system. The small sample size of 113 sepsis admissions may have affected the statistical significance of some risk factors. Patient adherence to prescribed antibiotics could not be tracked as a potential confounding factor. The use of electronic health records and the International Classification of Diseases, Tenth Revision codes for diagnosis and classification introduced potential misclassification risks. Additionally, patients seeking care at other hospitals may have led to underestimation of sepsis-related readmissions.

DISCLOSURES:

One author reported receiving support from a research and training grant from the National Institutes of Health National Heart, Lung, and Blood Institute.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.