Association between time to clinical stability and outcomes after discharge in hospitalized patients with community-acquired pneumonia

Stefano Aliberti, Paula Peyrani, Giovanni Filardo, Mehdi Mirsaeidi, Asad Amir, Francesco Blasi, Julio A. Ramirez

Research output: Contribution to journalArticle

28 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)482-488
Number of pages7
JournalChest
Volume140
Issue number2
DOIs
StatePublished - Aug 1 2011
Externally publishedYes

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Pneumonia
Hospitalization
Veterans Hospitals
Patient Discharge
Cohort Studies
Retrospective Studies
Observation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Association between time to clinical stability and outcomes after discharge in hospitalized patients with community-acquired pneumonia. / Aliberti, Stefano; Peyrani, Paula; Filardo, Giovanni; Mirsaeidi, Mehdi; Amir, Asad; Blasi, Francesco; Ramirez, Julio A.

In: Chest, Vol. 140, No. 2, 01.08.2011, p. 482-488.

Research output: Contribution to journalArticle

Aliberti, Stefano ; Peyrani, Paula ; Filardo, Giovanni ; Mirsaeidi, Mehdi ; Amir, Asad ; Blasi, Francesco ; Ramirez, Julio A. / Association between time to clinical stability and outcomes after discharge in hospitalized patients with community-acquired pneumonia. In: Chest. 2011 ; Vol. 140, No. 2. pp. 482-488.
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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.",
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