Stefano Aliberti1, Paula Peyrani2, Giovanni Filardo3, Mehdi Mirsaeidi2, Asad Amir2, Francesco Blasi4, Julio A Ramirez2. 1. Dipartimento toraco-polmonare e cardio-circolatorio, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: stefano.aliberti@unimib.it. 2. Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY. 3. Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX. 4. Dipartimento toraco-polmonare e cardio-circolatorio, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
BACKGROUND: Adverse outcomes after discharge in patients hospitalized for community-acquired pneumonia (CAP) might be associated with the inflammatory response during hospitalization, recognized by the length of time needed for the patient to reach clinical stability (time to clinical stability [TCS]). The objective of this study was to assess the association between TCS and outcomes after discharge in hospitalized patients with CAP. METHODS: A retrospective cohort study of consecutive patients discharged alive after an episode of CAP was conducted at the Veterans Hospital of Louisville, Kentucky, between 2001 and 2006. RESULTS: Among the 464 patients enrolled in the study, 82 (18%) experienced an adverse outcome within 30 days after discharge, leading to either readmission or death. Patients with a TCS > 3 days showed a significantly higher rate of adverse outcomes after discharge compared with those with a TCS ≤ 3 days (26% vs 15%, respectively; OR, 1.98; 95% CI, 1.19-3.3; P = .008) as well as adverse outcomes after discharge related to pneumonia (16% vs 4.6%, respectively; OR, 4.07; 95% CI, 2-8.2; P < .001). The propensity-adjusted analysis showed that delay in reaching TCS during hospitalization was associated with a significant increased risk of adverse outcomes. Adjusted ORs comparing patients who reached TCS at days 2, 3, 4, and 5 to those who reached TCS at day 1 were 1.06, 1.54, 2.40, and 10.53, respectively. CONCLUSIONS: Patients with CAP who experienced a delay in reaching clinical stability during hospitalization are at high risk of adverse outcomes after discharge and should receive close observation and an early follow-up.
BACKGROUND: Adverse outcomes after discharge in patients hospitalized for community-acquired pneumonia (CAP) might be associated with the inflammatory response during hospitalization, recognized by the length of time needed for the patient to reach clinical stability (time to clinical stability [TCS]). The objective of this study was to assess the association between TCS and outcomes after discharge in hospitalized patients with CAP. METHODS: A retrospective cohort study of consecutive patients discharged alive after an episode of CAP was conducted at the Veterans Hospital of Louisville, Kentucky, between 2001 and 2006. RESULTS: Among the 464 patients enrolled in the study, 82 (18%) experienced an adverse outcome within 30 days after discharge, leading to either readmission or death. Patients with a TCS > 3 days showed a significantly higher rate of adverse outcomes after discharge compared with those with a TCS ≤ 3 days (26% vs 15%, respectively; OR, 1.98; 95% CI, 1.19-3.3; P = .008) as well as adverse outcomes after discharge related to pneumonia (16% vs 4.6%, respectively; OR, 4.07; 95% CI, 2-8.2; P < .001). The propensity-adjusted analysis showed that delay in reaching TCS during hospitalization was associated with a significant increased risk of adverse outcomes. Adjusted ORs comparing patients who reached TCS at days 2, 3, 4, and 5 to those who reached TCS at day 1 were 1.06, 1.54, 2.40, and 10.53, respectively. CONCLUSIONS:Patients with CAP who experienced a delay in reaching clinical stability during hospitalization are at high risk of adverse outcomes after discharge and should receive close observation and an early follow-up.
Authors: Michael J Lanspa; Paula Peyrani; Timothy Wiemken; Emily L Wilson; Julio A Ramirez; Nathan C Dean Journal: J Hosp Med Date: 2014-11-01 Impact factor: 2.960
Authors: Thomas P Lodise; Antonio R Anzueto; David J Weber; Andrew F Shorr; Min Yang; Alexander Smith; Qi Zhao; Xingyue Huang; Thomas M File Journal: Antimicrob Agents Chemother Date: 2014-12-08 Impact factor: 5.191