Predictors of in-hospital mortality and length of stay in community-acquired pneumonia: a 5-year multi-centre case control study of adults in a developing country.

Autor:	Iroezindu MO; Department of Medicine, College of Medicine, University of Nigeria Ituku/Ozalla, PMB 01129 Enugu, Nigeria Department of Internal Medicine, Federal Medical Centre Owerri, PMB 1010 Owerri, Imo State, Nigeria mikezindu@yahoo.com michael.iroezindu@unn.edu.ng., Isiguzo GC; Department of Medicine, Federal Teaching Hospital Abakaliki, PMB 102 Abakaliki, Ebonyi State, Nigeria., Chima EI; Department of Medicine,Federal Medical Centre Umuahia, PMB 7001 Umuahia, Abia State, Nigeria., Mbata GC; Department of Internal Medicine, Federal Medical Centre Owerri, PMB 1010 Owerri, Imo State, Nigeria., Onyedibe KI; Department of Medical Microbiology, University of Jos, PMB 2083 Jos, Plateau State, Nigeria., Onyedum CC; Department of Medicine, College of Medicine, University of Nigeria Ituku/Ozalla, PMB 01129 Enugu, Nigeria., John-Maduagwu OJ; Department of Internal Medicine, Federal Medical Centre Owerri, PMB 1010 Owerri, Imo State, Nigeria., Okoli LE; Department of Internal Medicine, Federal Medical Centre Owerri, PMB 1010 Owerri, Imo State, Nigeria., Young EE; Department of Medicine, College of Medicine, University of Nigeria Ituku/Ozalla, PMB 01129 Enugu, Nigeria.
Jazyk:	angličtina
Zdroj:	Transactions of the Royal Society of Tropical Medicine and Hygiene [Trans R Soc Trop Med Hyg] 2016 Aug; Vol. 110 (8), pp. 445-55. Date of Electronic Publication: 2016 Sep 12.
DOI:	10.1093/trstmh/trw057
Abstrakt:	Background: We investigated predictors of in-hospital mortality and length of hospital stay among adults with community-acquired pneumonia (CAP) in Nigeria in order to provide recommendations to improve CAP outcomes in developing countries. Methods: This was a multi-centre case control study of patients ≥18 years who were admitted with CAP between 2008 and 2012. Case notes of 100 consecutive patients who died (cases) and random sample of 300 patients discharged (controls) were selected. Results: Mean ages were 55.4±19.6 (cases) and 49.3±19.2 (controls). Independent predictors of mortality were CURB-65 score ≥3: adjusted odds ratio (aOR) 24.3, late presentation: aOR 8.6, co-morbidity: aOR 3.9, delayed first dose antibiotics (>4 hours): aOR 3.5, need for supplemental oxygen: aOR 4.9, multilobar pneumonia: aOR 4.0, non-pneumococcal aetiology: aOR 6.5, anaemia: aOR 3.8 and hyperglycemia: aOR 8.6. CURB-65 ≥3 predicted mortality with a high specificity (96.1%) but low sensitivity (75%); positive predictive value of 88.2% and negative predictive value of 90.8%. Care in hospital A and B: aOR 3.3 and 2.2 respectively, male gender aOR 2.1, co-morbidity aOR 3.0, anaemia aOR 2.1 and elevated serum creatinine aOR 6.3 independently predicted length of hospital stay >10 days among survivors. Conclusions: Several modifiable patient-related and process-of-care factors predicted in-hospital mortality, and length of hospital stay among survivors. Our findings should be used to improve CAP outcomes in developing countries. (© The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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