Jasti Harish, Mortensen Eric M, Obrosky David Scott, Kapoor Wishwa N, Fine Michael J
Department of Medicine, Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Clin Infect Dis. 2008 Feb 15;46(4):550-6. doi: 10.1086/526526.
Rehospitalization after inpatient treatment of community-acquired pneumonia occurs in one-tenth of all hospitalizations, but the clinical circumstances surrounding readmission to the hospital have not been well studied. The objective of this study was to identify the causes and risk factors for rehospitalization of inpatients with community-acquired pneumonia.
This project was performed as part of a randomized, multicenter, controlled trial of the implementation of practice guidelines to reduce the duration of intravenous antibiotic therapy and duration of hospitalization for patients who have received a clinical and radiographic diagnosis of pneumonia. The trial was conducted at 7 hospitals in Pittsburgh, Pennsylvania, from February 1998 through March 1999. The primary outcome for these analyses was rehospitalization within 30 days after the index hospitalization. Two physicians independently assigned the cause of rehospitalization as pneumonia related, comorbidity related, or both; consensus was reached for all assignments. Patient demographic characteristics and clinical factors independently associated with rehospitalization were identified using multiple logistic regression analysis.
Of the 577 patients discharged after hospitalization for community-acquired pneumonia, 70 (12%) were rehospitalized within 30 days. The median time to rehospitalization was 8 days (interquartile range, 4-13 days). Overall, 52 rehospitalizations (74%) were comorbidity related, and 14 (20%) were pneumonia related. The most frequent comorbid conditions responsible for rehospitalization were cardiovascular (n = 19), pulmonary (n = 6) and neurological (n = 6) in origin. Less than a high school education (odds ratio, 2.0; 95% confidence interval, 1.1-3.4), unemployment (odds ratio, 3.7; 95% confidence interval, 1.1-12.3), coronary artery disease (odds ratio, 2.7; 95% confidence interval, 1.5-4.7), and chronic obstructive pulmonary disease (odds ratio, 2.3; 95% confidence interval, 1.3-4.1) were independently associated with rehospitalization.
The majority of rehospitalizations following pneumonia are comorbidity related and are the result of underlying cardiopulmonary and/or neurologic diseases. Careful attention to the clinical stability of patients with these coexisting conditions at and following hospital discharge may decrease the frequency of rehospitalization of patients with community-acquired pneumonia.
社区获得性肺炎住院治疗后再入院的情况在所有住院病例中占十分之一，但再次入院时的临床情况尚未得到充分研究。本研究的目的是确定社区获得性肺炎住院患者再入院的原因和危险因素。
本项目是一项随机、多中心、对照试验的一部分，该试验旨在实施实践指南，以缩短静脉抗生素治疗时间和肺炎临床及影像学诊断患者的住院时间。该试验于1998年2月至1999年3月在宾夕法尼亚州匹兹堡的7家医院进行。这些分析的主要结局是首次住院后30天内再入院。两名医生独立将再入院原因分为与肺炎相关、与合并症相关或两者皆有；所有分类均达成共识。使用多因素逻辑回归分析确定与再入院独立相关的患者人口统计学特征和临床因素。
在577例因社区获得性肺炎住院后出院的患者中，70例（12%）在30天内再次入院。再入院的中位时间为8天（四分位间距，4 - 13天）。总体而言，52例（74%）再入院与合并症相关，14例（20%）与肺炎相关。导致再入院的最常见合并症起源于心血管（n = 19）、肺部（n = 6）和神经系统（n = 6）。高中以下学历（比值比，2.0；95%置信区间，1.1 - 3.4）、失业（比值比，3.7；95%置信区间，1.1 - 12.3）、冠状动脉疾病（比值比，2.7；95%置信区间，1.5 - 4.7）和慢性阻塞性肺疾病（比值比，2.3；95%置信区间，1.3 - 4.1）与再入院独立相关。
肺炎后大多数再入院与合并症相关，是潜在心肺和/或神经系统疾病的结果。在出院时及出院后仔细关注这些并存疾病患者的临床稳定性，可能会降低社区获得性肺炎患者的再入院频率。
