title: Respiratory rate at intensive care unit discharge after liver transplant is an independent risk factor for intensive care unit readmission within the same hospital stay: a nested case-control study.
abstract: OBJECTIVE
  Intensive care unit (ICU) readmission negatively impacts patients' outcomes. We aimed to characterize and determine risk factors for ICU readmission within the initial hospital stay after liver transplant (LT).
  
  
  METHODS
  The reference cohort included 369 LT recipients from a Canadian center between 2005 and 2012. One control was randomly selected per each case of ICU readmission within the initial hospital stay after LT. Survival analysis used the Kaplan-Meier method. Associations were studied by conditional logistic regression.
  
  
  RESULTS
  Fifty-two (14%) LT recipients were readmitted to the ICU within the initial hospital stay after LT; they had longer first hospital stay (P < .001) and lower 1-month to 2-year cumulative survival (P < .001). Respiratory failure was the major cause of ICU readmission (61%). Respiratory rate at discharge from the first ICU stay after LT was an independent risk factor for ICU readmission (odds ratio = 1.24). The cutoff point more than 20 breaths per minute prognosticated ICU readmission with a specificity of 90% and a positive predictive value of 80%.
  
  
  CONCLUSIONS
  Intensive care unit readmission within the initial hospital stay after LT negatively impacts LT recipients' outcomes. Monitoring respiratory rate at discharge from the first ICU stay after LT is important to prevent readmission.
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C Mackenzie Center, 8440-112 ST NW, Edmonton, Alberta, T6G-2B7, Canada. Electronic address: desousac@ualberta.ca.
authors.forename: Filipe S
authors.initials: FS
authors.lastname: Cardoso
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C Mackenzie Center, 8440-112 ST NW, Edmonton, Alberta, T6G-2B7, Canada; Division of Gastroenterology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 130 University Campus NW, Edmonton, Alberta, T6G-2X8, Canada. Electronic address: dean.karvellas@ualberta.ca.
authors.forename: Constantine J
authors.initials: CJ
authors.lastname: Karvellas
authors.affiliation: Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, T6G-2B7, Canada. Electronic address: kneteman@ualberta.ca.
authors.forename: Norman M
authors.initials: NM
authors.lastname: Kneteman
authors.affiliation: Liver Transplant Program, Alberta Health Services, Edmonton, Alberta, T6G-2B7, Canada. Electronic address: meeberg@ualberta.ca.
authors.forename: Glenda
authors.initials: G
authors.lastname: Meeberg
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C Mackenzie Center, 8440-112 ST NW, Edmonton, Alberta, T6G-2B7, Canada. Electronic address: fidalgo@ualberta.ca.
authors.forename: Pedro
authors.initials: P
authors.lastname: Fidalgo
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C Mackenzie Center, 8440-112 ST NW, Edmonton, Alberta, T6G-2B7, Canada. Electronic address: bagshaw@ualberta.ca.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D000416:Alberta; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000150:complications; D056152:Respiratory Rate / Q000502:physiology*
keywords: Critical care; Early readmission; Liver transplantation; Predictors