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Original Research: CHEST INFECTIONS |

Association Between Time to Clinical Stability and Outcomes After Discharge in Hospitalized Patients With Community-Acquired PneumoniaDischarge Outcomes and Time to Clinical Stability

Stefano Aliberti, MD; Paula Peyrani, MD; Giovanni Filardo, PhD; Mehdi Mirsaeidi, MD, PhD; Asad Amir, MD; Francesco Blasi, MD, PhD; Julio A. Ramirez, MD
Author and Funding Information

From the Dipartimento toraco-polmonare e cardio-circolatorio (Drs Aliberti and Blasi), University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; Division of Infectious Diseases (Drs Peyrani, Mirsaeidi, Amir, and Ramirez), Department of Medicine, University of Louisville, Louisville, KY; and Institute for Health Care Research and Improvement (Dr Filardo), Baylor Health Care System, Dallas, TX.

Correspondence to: Stefano Aliberti, MD, Dipartimento toraco-polmonare e cardio-circolatorio, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; e-mail: stefano.aliberti@unimib.it


This work was presented at the European Respiratory Society Annual Congress 2009, September 12-16, 2009, Vienna, Austria.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):482-488. doi:10.1378/chest.10-2895
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Background:  Adverse outcomes after discharge in patients hospitalized for community-acquired pneumonia (CAP) might be associated with the inflammatory response during hospitalization, recognized by the length of time needed for the patient to reach clinical stability (time to clinical stability [TCS]). The objective of this study was to assess the association between TCS and outcomes after discharge in hospitalized patients with CAP.

Methods:  A retrospective cohort study of consecutive patients discharged alive after an episode of CAP was conducted at the Veterans Hospital of Louisville, Kentucky, between 2001 and 2006.

Results:  Among the 464 patients enrolled in the study, 82 (18%) experienced an adverse outcome within 30 days after discharge, leading to either readmission or death. Patients with a TCS > 3 days showed a significantly higher rate of adverse outcomes after discharge compared with those with a TCS ≤ 3 days (26% vs 15%, respectively; OR, 1.98; 95% CI, 1.19-3.3; P = .008) as well as adverse outcomes after discharge related to pneumonia (16% vs 4.6%, respectively; OR, 4.07; 95% CI, 2-8.2; P < .001). The propensity-adjusted analysis showed that delay in reaching TCS during hospitalization was associated with a significant increased risk of adverse outcomes. Adjusted ORs comparing patients who reached TCS at days 2, 3, 4, and 5 to those who reached TCS at day 1 were 1.06, 1.54, 2.40, and 10.53, respectively.

Conclusions:  Patients with CAP who experienced a delay in reaching clinical stability during hospitalization are at high risk of adverse outcomes after discharge and should receive close observation and an early follow-up.

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