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Original Research: PNEUMONIA |

Predictors of Short-term Rehospitalization Following Discharge of Patients Hospitalized With Community-Acquired Pneumonia

Alberto Capelastegui, MD, PhD; Pedro P. España Yandiola, MD; José M. Quintana, MD, PhD; Amaia Bilbao, MSc; Rosa Diez, RN; Silvia Pascual, MD; Esther Pulido, MD; Mikel Egurrola, MD
Author and Funding Information

Affiliations: From the Pneumology Service (Drs. Capelastegui, España Yandiola, Pascual, and Egurrola, and Ms. Diez), the Department of Emergency Medicine (Dr. Pulido), and the Research Unit (Dr. Quintana), Hospital Galdakao-Usansolo-Centro de Investigacíon Biomedica en Red Epidemiología y Salud Pública, Galdakao, Bizkaia, Spain; and the Basque Foundation for Health Innovation and Research-Centro de Investigacíon Biomedica en Red Epidemiología y Salud Pública (Ms. Bilbao), Sondika, Bizkaia, Spain.

Correspondence to: Alberto Capelastegui, MD, PhD, Service of Pneumology, Hospital de Galdakao-Usansolo, E-48960 Galdakao, Bizkaia, Spain; e-mail: alberto.capelasteguisaiz@osakidetza.net


This research was supported in part by grants from the Fondo de Investigación Sanitaria (PI07/90339).

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


© 2009 American College of Chest Physicians


Chest. 2009;136(4):1079-1085. doi:10.1378/chest.08-2950
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Background:  Among patients hospitalized for community-acquired pneumonia (CAP), the risk factors for short-term hospital readmission after discharge are unknown.

Methods:  We conducted a prospective observational study of 1,117 patients who had been discharged alive after hospitalization for CAP. We collected variables associated with CAP severity at hospital admission, in-hospital clinical evolution, clinical instability factors on hospital discharge, therapy employed during hospitalization, and diagnostic bacteriology. We assessed hospital readmission within 30 days after discharge for the index hospitalization. Risk factors independently associated with 30-day hospital readmission were identified using Cox regression models.

Results:  Of the 81 patients (7.3%) who were readmitted to the hospital within 30 days, 29 (35.8%) were rehospitalized for pneumonia-related causes. Variables associated with pneumonia-related hospital readmission were treatment failure (hazard ratio [HR], 2.9; 95% CI, 1.2 to 6.8), and one or more instability factors on hospital discharge (HR, 2.8; 95% CI, 1.3 to 6.2). The predictive performance of these variables measured by the area under the curve (AUC) of the receiver operating characteristic was 0.65. Variables associated with pneumonia-unrelated hospital readmission were age ≥ 65 years (HR, 4.5; 95% CI, 1.4 to 14.7), Charlson comorbidity index ≥ 2 (HR, 1.9; 95% CI, 1.0 to 3.4), and decompensated comorbidities during in-hospital evolution (HR, 3.5; 95% CI, 2.0 to 6.3); the AUC for this model was 0.77. Patients with at least two risk factors were at significantly increased risk of 30-day hospital readmission (pneumonia-related CAP: HR, 9.0; 95% CI, 3.2 to 25.3; pneumonia-unrelated CAP: HR, 5.3; 95% CI, 1.6 to 18.1).

Conclusions:  Among patients hospitalized for CAP, different risk factors are associated with hospital readmission related to pneumonia or to other causes. The identification of two different groups of patients who were at high risk of hospital readmission raises the possibility that different management strategies could decrease the rate of hospital readmissions.

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