Predictors of Short-term Rehospitalization Following Discharge of Patients Hospitalized With Community-Acquired Pneumonia.
Chest. 2009 Apr 24;
Authors: Capelastegui A, España PP, Quintana JM, Bilbao A, Diez R, Pascual S, Pulido E, Egurrola M
Background Among patients hospitalized for community-acquired pneumonia (CAP), risk factors for short-term readmission after discharge are unknown. Methods Prospective observational study of 1117 patients discharged alive after hospitalization for CAP. We collected variables associated with CAP severity at admission, in-hospital clinical evolution, clinical instability factors on discharge, therapy employed during hospitalization, and diagnostic bacteriology. We assessed readmission within 30 days after discharge for the index hospitalization. Risk factors independently associated with 30-day readmission were identified using Cox regression models. Results Of the 81 (7.3%) patients readmitted within 30 days, 29 (35.8%) were rehospitalized for pneumonia-related causes. Variables associated with pneumonia-related readmission were treatment failure (hazard ratio (HR), 2.9; 95% confidence interval (CI), 1.2-6.8), and >/= 1 instability factor on discharge (HR, 2.8; 95% CI, 1.3-6.2). The predictive performance of these variables measured by area under the ROC curve (AUC) was 0.65. Variables associated with pneumonia-unrelated readmission were age >/= 65 years (HR, 4.5; 95% CI, 1.4-14.7), Charlson index >/= 2 (HR, 1.9; 95% CI, 1.0-3.4), and decompensated comorbidities during in-hospital evolution (HR, 3.5; 95% CI, 2.0-6.3); the AUC for this model was 0.77. Patients with at least 2 risk factors were at significantly increased risk of 30-day readmission (pneumonia-related, HR 9.0, 95% CI 3.2-25.3; pneumonia-unrelated, HR 5.3, 95% CI 1.6-18.1). Conclusions Among patients hospitalized for CAP, different risk factors are associated with readmission related to pneumonia or to other causes. Identification of two different groups at high risk of readmission raises the possibility that different management strategies could decrease the rate of readmissions.
PMID: 19395580 [PubMed - as supplied by publisher]