| Predictors of short-term rehospitalization following discharge of patients hospitalized with community-acquired pneumonia. | |
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MedLine Citation:
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PMID: 19395580 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 >or= 65 years (HR, 4.5; 95% CI, 1.4 to 14.7), Charlson comorbidity index >or= 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. |
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Authors:
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Alberto Capelastegui; Pedro P España Yandiola; José M Quintana; Amaia Bilbao; Rosa Diez; Silvia Pascual; Esther Pulido; Mikel Egurrola |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2009-04-24 |
Journal Detail:
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Title: Chest Volume: 136 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-07 Completed Date: 2009-11-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: 1079-85 Citation Subset: AIM; IM |
Affiliation:
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Service of Pneumology, Hospital Galdakao-Usansolo-Centro de Investigacíon Biomedica en Red Epidemiología y Salud Pública, Galdakao, Bizkaia, Spain. alberto.capelasteguisaiz@osakidetza.net |
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| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Community-Acquired Infections / therapy* Comorbidity Hospitalization Humans Length of Stay Models, Statistical Patient Readmission / statistics & numerical data* Pneumonia / therapy* Prospective Studies ROC Curve Risk Factors Treatment Outcome |
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