Predictors of In-hospital versus Post-discharge Mortality in Pneumonia.
Chest. 2012 Mar 1;
Authors: Metersky ML, Waterer G, Nsa W, Bratzler DW
Abstract
Abstract BACKGROUND:Many patients who die within 30 days of admission to the hospital for pneumonia die after discharge. Recently, 30-day mortality for pneumonia patients became a publicly reported performance measure, meaning that hospitals are, in part, being measured based on how the patient fares after discharge from the hospital. This study was done to determine what factors predict in-hospital versus post-discharge mortality in patients with pneumonia. METHODS:This was a retrospective analysis of a database of 21,233 Medicare patients age 65 years and greater admitted to the hospital between 2000-2001. Multivariate logistic regression analyses were performed to determine the association between 26 patient characteristics and the timing of death (in-hospital vs post-discharge) among those patients who died within 30 days of hospital admission. RESULTS:Among the 21,233 patients, 2561 (12.1%) died within 30 days of admission, 1343 (52.4%) during the hospital stay and 1218 (47.6%) after discharge. Multivariate logistic regression demonstrated that 7 factors were significantly associated with death prior to discharge: Systolic blood pressure <90 mmHg, respiration rate >30/minute, bacteremia, arterial pH <7.35, blood urea nitrogen >11 mmol/L, arterial PO2 <60 mmHg or Sa O2< 90% and need for mechanical ventilation. Some underlying comorbidities were associated with a non-statistically significant trend towards death after discharge. CONCLUSIONS:Of elderly patients dying within 30 days of admission to the hospital, approximately half die after discharge from the hospital. Comorbidities, in general, were equally associated with death in the hospital and death after discharge.
PMID: 22383662 [PubMed - as supplied by publisher]