社区获得性肺炎患者住院时间、再住院率和死亡率的预测因素：一项回顾性队列研究
Predictors of Length of Stay, Rehospitalization and Mortality in Community-Acquired Pneumonia Patients: A Retrospective Cohort Study.
作者信息
Lüthi-Corridori Giorgia, Boesing Maria, Roth Andrea, Giezendanner Stéphanie, Leuppi-Taegtmeyer Anne Barbara, Schuetz Philipp, Leuppi Joerg D
机构信息
University Centre of Internal Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland.
Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland.
出版信息
J Clin Med. 2023 Aug 28;12(17):5601. doi: 10.3390/jcm12175601.
BACKGROUND
Community-acquired pneumonia (CAP) represents one of the leading causes of hospitalization and has a substantial impact on the financial burden of healthcare. The aim of this study was to identify factors associated with the length of hospital stay (LOHS), rehospitalization and mortality of patients admitted for CAP.
METHODS
A retrospective cohort study was conducted with patients presenting to a Swiss public hospital between January 2019 and December 2019. Zero-truncated negative binomial and multivariable logistic regression analyses were performed to assess risk factors.
RESULTS
A total of 300 patients were analyzed (median 78 years, IQR [67.56, 85.50] and 53% males) with an average LOHS of 7 days (IQR [5.00, 9.00]). Of the 300 patients, 31.6% (97/300) were re-hospitalized within 6 months, 2.7% (8/300) died within 30 days and 11.7% (35/300) died within 1 year. The results showed that sex (IRR = 0.877, 95% CI = 0.776-0.992, -value = 0.036), age (IRR = 1.007, 95% CI = 1.002-1.012, -value = 0.003), qSOFA score (IRR = 1.143, 95% CI = 1.049-1.246, -value = 0.002) and atypical pneumonia (IRR = 1.357, 95% CI = 1.012-1.819, -value = 0.04) were predictive of LOHS. Diabetes (OR = 2.149, 95% CI = 1.104-4.172, -value = 0.024), a higher qSOFA score (OR = 1.958, 95% CI = 1.295-3.002, -value = 0.002) and rehabilitation after discharge (OR = 2.222, 95% CI = 1.017-4.855, -value = 0.044) were associated with a higher chance of being re-hospitalized within 6 months, whereas mortality within 30 days and within one year were both associated with older age (OR = 1.248, 95% CI = 1.056-1.562, -value = 0.026 and OR = 1.073, 95% CI = 1.025-1.132, -value = 0.005, respectively) and the presence of a cancer diagnosis (OR = 32.671, 95% CI = 4.787-369.1, -value = 0.001 and OR = 4.408, 95% CI = 1.680-11.43, -value = 0.002, respectively).
CONCLUSION
This study identified routinely available predictors for LOHS, rehospitalization and mortality in patients with CAP, which may further advance our understanding of CAP and thereby improve patient management, discharge planning and hospital costs.
背景
社区获得性肺炎（CAP）是住院的主要原因之一，对医疗保健的经济负担有重大影响。本研究的目的是确定与CAP住院患者的住院时间（LOHS）、再次住院和死亡率相关的因素。
方法
对2019年1月至2019年12月期间在瑞士一家公立医院就诊的患者进行回顾性队列研究。进行零截断负二项式和多变量逻辑回归分析以评估危险因素。
结果
共分析了300例患者（中位年龄78岁，IQR[67.56,85.50]，男性占53%），平均住院时间为7天（IQR[5.00,9.00]）。在这300例患者中，31.6%（97/300）在6个月内再次住院，2.7%（8/300）在30天内死亡，11.7%（35/300）在1年内死亡。结果显示，性别（IRR = 0.877，95%CI = 0.776 - 0.992，P值 = 0.036）、年龄（IRR = 1.007，95%CI = 1.002 - 1.012，P值 = 0.003）、qSOFA评分（IRR = 1.143，95%CI = 1.049 - 1.246，P值 = 0.002）和非典型肺炎（IRR = 1.357，95%CI = 1.012 - 1.819，P值 = 0.04）可预测住院时间。糖尿病（OR = 2.149，95%CI = 1.104 - 4.172，P值 = 0.024）、较高的qSOFA评分（OR = 1.958，95%CI = 1.295 - 3.002，P值 = 0.002）和出院后康复（OR = 2.222，95%CI = 1.017 - 4.855，P值 = 0.044）与6个月内再次住院的可能性较高相关，而30天内和1年内的死亡率均与年龄较大（OR = 1.248，95%CI = 1.056 - 1.562，P值 = 0.026和OR = 1.073，95%CI = 1.025 - 1.132，P值 = 0.005）以及癌症诊断的存在（OR = 32.671，95%CI = 4.787 - 369.1，P值 = 0.001和OR = 4.408，95%CI = 1.680 - 11.43，P值 = 0.002）相关。
结论
本研究确定了CAP患者住院时间、再次住院和死亡率的常规可用预测因素，这可能进一步推进我们对CAP的理解，从而改善患者管理、出院计划和医院成本。
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