Predictors of Short-term Rehospitalization Following Discharge of Patients Hospitalized With Community-Acquired Pneumonia
| Autor: | Amaia Bilbao, Silvia Pascual, Rosa Diez, Alberto Capelastegui, José M. Quintana, Pedro P. España Yandiola, Mikel Egurrola, Esther Pulido |
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| Rok vydání: | 2009 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Pediatrics Comorbidity Critical Care and Intensive Care Medicine Patient Readmission Community-acquired pneumonia Risk Factors Internal medicine medicine Humans Prospective Studies Prospective cohort study Aged Models Statistical Proportional hazards model business.industry Hazard ratio Age Factors Bacterial pneumonia Area under the curve Pneumonia Length of Stay medicine.disease Community-Acquired Infections Hospitalization Treatment Outcome ROC Curve Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 136:1079-1085 |
| ISSN: | 0012-3692 |
| Popis: | Background Among patients hospitalized for community-acquired pneumonia (CAP), the risk factors for short-term hospital readmission after discharge are unknown. Methods We conducted a prospective observational study of 1,117 patients who had been discharged alive after hospitalization for CAP. We collected variables associated with CAP severity at hospital admission, in-hospital clinical evolution, clinical instability factors on hospital discharge, therapy employed during hospitalization, and diagnostic bacteriology. We assessed hospital readmission within 30 days after discharge for the index hospitalization. Risk factors independently associated with 30-day hospital readmission were identified using Cox regression models. Results Of the 81 patients (7.3%) who were readmitted to the hospital within 30 days, 29 (35.8%) were rehospitalized for pneumonia-related causes. Variables associated with pneumonia-related hospital readmission were treatment failure (hazard ratio [HR], 2.9; 95% CI, 1.2 to 6.8), and one or more instability factors on hospital discharge (HR, 2.8; 95% CI, 1.3 to 6.2). The predictive performance of these variables measured by the area under the curve (AUC) of the receiver operating characteristic was 0.65. Variables associated with pneumonia-unrelated hospital readmission were age ≥ 65 years (HR, 4.5; 95% CI, 1.4 to 14.7), Charlson comorbidity index ≥ 2 (HR, 1.9; 95% CI, 1.0 to 3.4), and decompensated comorbidities during in-hospital evolution (HR, 3.5; 95% CI, 2.0 to 6.3); the AUC for this model was 0.77. Patients with at least two risk factors were at significantly increased risk of 30-day hospital readmission (pneumonia-related CAP: HR, 9.0; 95% CI, 3.2 to 25.3; pneumonia-unrelated CAP: HR, 5.3; 95% CI, 1.6 to 18.1). Conclusions Among patients hospitalized for CAP, different risk factors are associated with hospital readmission related to pneumonia or to other causes. The identification of two different groups of patients who were at high risk of hospital readmission raises the possibility that different management strategies could decrease the rate of hospital readmissions. |
| Databáze: | OpenAIRE |
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