Predictors of Short-term Rehospitalization Following Discharge of Patients Hospitalized With Community-Acquired Pneumonia

摘要

Background: Among patients hospitalized for community-acquired pneumonia (CAP), the risknfactors for short-term hospital readmission after discharge are unknown.nMethods: We conducted a prospective observational study of 1,117 patients who had beenndischarged alive after hospitalization for CAP. We collected variables associated with CAPnseverity at hospital admission, in-hospital clinical evolution, clinical instability factors on hospitalndischarge, therapy employed during hospitalization, and diagnostic bacteriology. We assessednhospital readmission within 30 days after discharge for the index hospitalization. Risk factorsnindependently associated with 30-day hospital readmission were identified using Cox regressionnmodels.nResults: Of the 81 patients (7.3%) who were readmitted to the hospital within 30 days, 29 (35.8%)nwere rehospitalized for pneumonia-related causes. Variables associated with pneumonia-relatednhospital readmission were treatment failure (hazard ratio [HR], 2.9; 95% CI, 1.2 to 6.8), and onenor more instability factors on hospital discharge (HR, 2.8; 95% CI, 1.3 to 6.2). The predictivenperformance of these variables measured by the area under the curve (AUC) of the receivernoperating characteristic was 0.65. Variables associated with pneumonia-unrelated hospitalnreadmission were age > 65 years (HR, 4.5; 95% CI, 1.4 to 14.7), Charlson comorbidity index > 2n(HR, 1.9; 95% CI, 1.0 to 3.4), and decompensated comorbidities during in-hospital evolution (HR,n3.5; 95% CI, 2.0 to 6.3); the AUC for this model was 0.77. Patients with at least two risk factorsnwere at significantly increased risk of 30-day hospital readmission (pneumonia-related CAP: HR,n9.0; 95% CI, 3.2 to 25.3; pneumonia-unrelated CAP: HR, 5.3; 95% CI, 1.6 to 18.1).nConclusions: Among patients hospitalized for CAP, different risk factors are associated withnhospital readmission related to pneumonia or to other causes. The identification of two differentngroups of patients who were at high risk of hospital readmission raises the possibility thatndifferent management strategies could decrease the rate of hospital readmissions.