Sharma Yogesh, Mangoni Arduino A, Shahi Rashmi, Horwood Chris, Thompson Campbell
Department of Acute and General Medicine, Flinders Medical Centre, Adelaide 5042, Australia.
College of Medicine & Public Health, Flinders University, Adelaide 5042, Australia.
J Clin Med. 2025 Jul 25;14(15):5273. doi: 10.3390/jcm14155273.
: Clinical stability within 24 h prior to discharge is a key metric for safe care transitions in hospitalised patients with community-acquired pneumonia (CAP). However, its association with post-discharge outcomes, particularly readmissions, remains underexplored. This study assessed whether clinical instability before discharge is associated with 30-day mortality, readmissions, or a composite of both in hospitalised CAP patients. : This retrospective cohort study included adults (≥18 years) admitted with CAP to two tertiary Australian hospitals between 1 January 2020 and 31 December 2023. Clinical instability was defined as abnormal vital signs (temperature, heart rate, respiratory rate, blood pressure, or oxygen saturation) within 24 h before discharge. Pneumonia severity was assessed using the CURB-65 score and frailty using the Hospital Frailty Risk Score. Multilevel logistic regression models were used to evaluate associations with outcomes, adjusting for age, sex, comorbidities, frailty, disease severity, microbiological aetiology, antibiotics prescribed during admission, and prior healthcare use. Competing risk regression accounted for death when analysing readmissions. : Of 3984 patients, 20.4% had clinical instability within 24 h before discharge. The composite outcome occurred in 21.9% patients, with 15.8% readmitted and 6.1% dying within 30 days. Clinical instability was significantly associated with the composite outcome (adjusted odds ratio [aOR] 1.73, 95% CI 1.42-2.09, < 0.001), primarily driven by increased mortality risk (aOR 3.70, 95% CI 2.73-5.00, < 0.001). However, no significant association was found between clinical instability and readmissions (aOR 1.16, 95% CI 0.93-1.44, > 0.05). : Clinical instability within 24 h before discharge predicts worse outcomes in CAP patients, driven by increased mortality risk rather than readmissions.
出院前24小时内的临床稳定性是社区获得性肺炎（CAP）住院患者安全护理转接的关键指标。然而，其与出院后结局，尤其是再入院的关联仍未得到充分研究。本研究评估了出院前的临床不稳定是否与CAP住院患者的30天死亡率、再入院率或两者的综合情况相关。
这项回顾性队列研究纳入了2020年1月1日至2023年12月31日期间因CAP入住澳大利亚两家三级医院的成年人（≥18岁）。临床不稳定定义为出院前24小时内生命体征（体温、心率、呼吸频率、血压或血氧饱和度）异常。使用CURB - 65评分评估肺炎严重程度，使用医院衰弱风险评分评估衰弱程度。采用多水平逻辑回归模型评估与结局的关联，并对年龄、性别、合并症、衰弱、疾病严重程度、微生物病因、入院期间开具的抗生素以及既往医疗使用情况进行校正。在分析再入院情况时，竞争风险回归考虑了死亡因素。
在3984例患者中，20.4%在出院前24小时内存在临床不稳定。21.9%的患者出现了综合结局，其中15.8%再入院，6.1%在30天内死亡。临床不稳定与综合结局显著相关（校正比值比[aOR] 1.73，95%可信区间[CI] 1.42 - 2.09，P < 0.001），主要由死亡风险增加驱动（aOR 3.70，95% CI 2.73 - 5.00，P < 0.001）。然而，未发现临床不稳定与再入院之间存在显著关联（aOR 1.16，95% CI 0.93 - 1.44，P > 0.05）。
出院前24小时内的临床不稳定预示着CAP患者结局更差，其原因是死亡风险增加而非再入院。
