SESSION TITLE: Chest infections Posters II
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: To look at outcomes of MRSA pneumonia and identify predictors of bad outcome
METHODS: We used the Nationwide Inpatient Sample (NIS) database to identify patients with MRSA pneumonia through ICD-9-CM code 482.42 from years 2009-2011. We studied three outcomes, Mortality, Length of stay (LOS) and Acute respiratory distress syndrome (ARDS). We also looked at whether age, gender or Charlson's comorbidity index (CCI) had any impact on these outcomes. We used logistic regression for estimation of odds ratio for ARDS and mortality and linear regression for the logarithm of LOS. All analyses were adjusted for the survey design.
RESULTS: There were 44,372 records with MRSA pneumonia from 2009 through 2011, representing 219,184 discharges nationwide. The overall mortality of patient with MRSA pneumonia was 13.9%. 20.4% of patients had a LOS > 20 days. The percentage of patient with MRSA pneumonia who had ARDS was 0.8%. Impact of CCI: the estimated odds ratio for a 1 point increase in CCI for ARDS was 0.98 (95%CI 0.92-1.04, p value 0.49), for mortality, it was 1.10 (95%CI 1.08-1.11, p value <0.0001) and for LOS, it was 1.01 (95%CI 1.004-1.013, p value 0.0002) Impact of age: the estimated odds ratio for a 10 year increase in age for ARDS was 0.92 (95%CI 0.86-0.98, p value 0.0084), for mortality, it was 1.20 (95%CI 1.18-1.23, p value <0.0001) and for LOS, it was 0.96 (95%CI 0.956-0.968, p value <0.001) Impact of gender: the estimated odds ratio for gender (male is baseline) in ARDS is 0.97 (95%CI 0.78-1.19, p value 0.75), for mortality, it was 0.86 (95%CI 0.81-0.91, p value <0.0001) and for LOS is 0.95 (95%CI 0.938-0.969, p value <0.0001)
CONCLUSIONS: MRSA pneumonia has a mortality of 13.9%. From our analysis, it seems that all three variables, age, gender and CCI, affect mortality. A 10 year increase in age raises the odds of mortality by 20%. A rise in CCI by 1 increases the odds of mortality by 10%. Women have 14% less odds of dying than men. Similarly, for ARDS, only age seems to have a significant impact on this outcome. For every 10 rise in age, the ARDS odds are 8% less. In case of the LOS, a 10 year increase in age decreases the LOS by 4%, Being female reduces the LOS by 5% and for every 1 point rise in CCI, the LOS increases by 1%.
CLINICAL IMPLICATIONS: MRSA pneumonia mortality is higher for older patients with more co-morbidities. Presence of ARDS does not seem to be affected by Co-morbidities and is inversely related to age. Females have a lower mortality and lower LOS.
DISCLOSURE: The following authors have nothing to disclose: Saqib Baig, Ezza Khan, Aniko Szabo, Nicholas DeVogel
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