Chest
Volume 140, Issue 2, August 2011, Pages 482-488
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Original Research
Chest Infections
Association Between Time to Clinical Stability and Outcomes After Discharge in Hospitalized Patients With Community-Acquired Pneumonia

https://doi.org/10.1378/chest.10-2895Get rights and content

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.

Section snippets

Study Design and Study Patients

This was a retrospective cohort study of consecutive patients with CAP admitted to the Veterans Administration Medical Center (VAMC) of Louisville, Kentucky, between June 2001 and March 2006. Patients enrolled in this study are part of the Community-Acquired Pneumonia Organization (CAPO) database.11 The institutional review board of the VAMC approved the study (Human Study Subcommittee, CAPO IRB #: 0061).

Patients aged ≥ 18 years who met the criteria for CAP were included in this study. In order

Study Population

Among 500 consecutive patients hospitalized for CAP during the study period, 36 died during hospitalization. Thus, a total of 464 patients were enrolled in the study. Demographics; severity of disease; clinical, laboratory, and radiologic findings; microbiology and antibiotic data; and outcomes of the study population are summarized in Table 1. Patients with an early improvement who reached clinical stability within 72 h of hospitalization (group early) numbered 348 (75%), whereas those who

Discussion

This study indicates that the TCS in patients with CAP during the hospital course is significantly associated with adverse outcomes after discharge. Patients with CAP who experienced a delay in reaching clinical stability during hospitalization had a higher risk of adverse outcomes within 30 days after discharge.

TCS has been widely accepted as a tool to guide the switch from IV to oral antibiotic therapy during hospitalization as well as to judge appropriateness for hospital discharge.14

Acknowledgments

Author contributions: Dr Aliberti had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Aliberti: contributed to the conception and design of the study; acquisition, analysis, and interpretation of data; drafting of the manuscript; and revising of the manuscript critically for important intellectual content.

Dr Peyrani: contributed to the conception and design of the study, analysis and interpretation of

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  • Cited by (0)

    This work was presented at the European Respiratory Society Annual Congress 2009, September 12-16, 2009, Vienna, Austria.

    Funding/Support: The authors have reported to CHEST that no funding was received for this study.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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