Tonouchi Yuuto, Kataoka Yuki
Department of Rehabilitation, Kyoto Min-iren Asukai Hospital, Kyoto, JPN.
Department of Healthcare Epidemiology, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, JPN.
Cureus. 2023 Dec 31;15(12):e51380. doi: 10.7759/cureus.51380. eCollection 2023 Dec.
Background Pneumonia is a major concern among the elderly, with high readmission rates after hospitalization. These readmissions increase medical costs and reflect the quality of hospital care. This study aimed to explore the predictive factors associated with readmission within 30 days among elderly patients with pneumonia. Methodology This retrospective cohort study utilized the existing medical records. We included patients with pneumonia aged 75 and above who were discharged from a community hospital between April 2016 and March 2022. Patients who died during hospitalization or were transferred to other hospitals were excluded. Sex, age, length of hospital stay, Barthel Index (BI) at discharge, height, weight, body mass index, blood test findings, presence of tube feeding, Charlson Comorbidity Index, neutrophil-to-lymphocyte ratio (NLR), and Geriatric Nutritional Risk Index were used as predictive factors. The primary outcome was readmission within 30 days of discharge. A logistic regression analysis was performed. Results We included 337 patients: 50 (15%) in the readmission group and 287 (85%) in the control group. Univariate logistic regression analysis indicated low BI at discharge, and the odds ratio (OR) for readmission was 0.99 (95% confidence interval (CI) = 0.98-1.00). In patients with hemoglobin 10.0 g/dL or less, the OR for readmission was 2.18 (95% CI = 1.08-4.28). In patients with an NLR of 5 points or more, the OR for readmission was 2.64 (95% CI = 1.30 -5.24). In patients with aspartate transaminase of 38 U/L or more, the OR for readmission was 2.99 (95% CI = 1.07-7.68). Multivariate logistic regression revealed that an NLR of 5 points or more (adjusted OR = 2.42, 95% CI = 1.12-5.14) was correlated with readmission in elderly pneumonia patients. Conclusions In elderly patients with pneumonia, a high NLR at discharge may be a potential predictor of readmission within 30 days. This could be a new finding of our study. By sharing these findings during patient discharge conferences, there is potential to assist the medical team, patients, and caregivers in predicting unforeseen short-term readmissions. Further high-quality research is required to verify the reproducibility of these findings.
肺炎是老年人的主要关切问题，住院后再入院率很高。这些再入院增加了医疗成本，并反映了医院护理质量。本研究旨在探讨老年肺炎患者30天内再入院的相关预测因素。
这项回顾性队列研究利用了现有的医疗记录。我们纳入了2016年4月至2022年3月间从社区医院出院的75岁及以上的肺炎患者。排除住院期间死亡或转至其他医院的患者。将性别、年龄、住院时间、出院时的Barthel指数（BI）、身高、体重、体重指数、血液检查结果、鼻饲情况、Charlson合并症指数、中性粒细胞与淋巴细胞比值（NLR）以及老年营养风险指数作为预测因素。主要结局是出院后30天内再入院。进行了逻辑回归分析。
我们纳入了337例患者：再入院组50例（15%），对照组287例（85%）。单因素逻辑回归分析表明出院时BI较低，再入院的比值比（OR）为0.99（95%置信区间（CI）=0.98 - 1.00）。血红蛋白10.0 g/dL及以下的患者，再入院的OR为2.18（95% CI = 1.08 - 4.28）。NLR为5分及以上的患者，再入院的OR为2.64（95% CI = 1.30 - 5.24）。天冬氨酸转氨酶38 U/L及以上的患者，再入院的OR为2.99（95% CI = 1.07 - 7.68）。多因素逻辑回归显示，NLR为5分及以上（调整后的OR = 2.42，95% CI = 1.12 - 5.14）与老年肺炎患者再入院相关。
在老年肺炎患者中，出院时高NLR可能是30天内再入院的潜在预测因素。这可能是我们研究的一个新发现。通过在患者出院会议上分享这些发现，有可能帮助医疗团队、患者和护理人员预测不可预见的短期再入院情况。需要进一步的高质量研究来验证这些发现的可重复性。
