EVALI Hospitalization Stay Linked to Readmission Risk

is commonly associated with short-term residual respiratory symptoms and abnormalities in smokers, according to new findings.

In data from a trial planned for presentation at the American Thoracic Society (ATS) 2020 International Conference this year, a team of investigators from Intermountain Healthcare in Salt Lake City reported that symptomatic EVALI is associated with lengthened respiratory burdens—upwards of 100 days post-hospital discharge.

Investigators, led by Denitza P. Blagev, MD, sought to better understand the recently established EVALI syndrome in e-cigarette or vape device users. It is currently unclear, they noted, whether clinical course changes in patients following hospital discharge.

“It is unknown whether patients will have resolution of radiographic or pulmonary function test (PFTs) abnormalities,” they wrote. “Whether severity of illness and length of stay are associated with increased risk of hospital readmission remains unknown.”

Blagev and colleagues conducted a review of PFTs, chest imaging, and reported symptoms of hospital survivors with EVALI, diagnosed at Intermountain Healthcare facilities between June 1, 2019-January 13, 2020. The team also assessed emergency department (ED) or urgent care (UC) usage within 30 days post-discharge.

Investigators compared proportions of outcomes using Fisher’s exact test, and compared central tendencies using Wilcoxon rank-sum. Associations between hospital and ICU length of stay and 30-day readmission were modeled with univariate logistic regression.

Of the 114 EVALI-diagnosed patients, 111 survived beyond 30 days post-discharge. About half (n = 54 [49%]) had clinic follow-up, with 19 (35%) reporting residual symptoms for a median of 15.5 days (interquartile range [IQR], 8-25).

Another 43 (38%) of patients had follow-up chest X-rays performed; 22 of them (51%) had residual abnormalities at a median of 22 days (IQR, 14-47). Another 30 patients overall (27%) had PFTs, with 17 (57%) reporting abnormal results at a median of 29 days (IQR, 12-49).

Of the 106 who were at least 30 days post-discharge for hospital readmission, UC, and ED visits, 7 (7%) were readmitted within 30 days. Another 13 (14%) had an ED or UC visit within 30 days, with the majority of visits being due to pulmonary complaints (7 [54%]).

No association was observed between ventilatory support (11% vs 3%; P = .124) or ICU admission (11% vs 4%; P = .22) during initial hospitalization as well as 30-day readmission.

In Blagev and colleagues’ univariate regression assessment, hospital length of stay was associated with greater odds of patient readmission (OR, 1.14; 95% CI, 1.03-1.27; P = .013).

Patients with EVALI who were readmitted had longer hospitalization stays (median 10 vs 4 days; P = .0045), but not longer stays in the ICU.

“In patients diagnosed with EVALI, residual respiratory symptoms and abnormalities are common at short-term follow-up,” investigators concluded. “Patients with longer hospitalizations are more likely to be readmitted in the subsequent 30 days.”

The study, “Short Term Follow-Up and Readmission Risk Factors in Patients with E-Cigarette, or Vaping, Associated Lung Injury (EVALI),” was published online by ATS.