Document Detail


Predictors of short-term rehospitalization following discharge of patients hospitalized with community-acquired pneumonia.
MedLine Citation:
PMID:  19395580     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Alberto Capelastegui; Pedro P España Yandiola; José M Quintana; Amaia Bilbao; Rosa Diez; Silvia Pascual; Esther Pulido; Mikel Egurrola
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-04-24
Journal Detail:
Title:  Chest     Volume:  136     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2009-11-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1079-85     Citation Subset:  AIM; IM    
Affiliation:
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:
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

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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