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Predictors for length of hospital stay in patients with community-acquired pneumonia: results from a Swiss multicenter study.

Suter-Widmer I, Christ-Crain M, Zimmerli W, Albrich W, Mueller B, Schuetz P, ProHOSP Study Gro - BMC Pulm Med (2012)

Bottom Line: When also considering follow-up information, low albumin levels, ICU transfer and development of CAP-associated complications were additional independent risk factors for prolonged LOS.Both weighted clinical prediction rules based on these factors showed a high separation of patients in Kaplan Meier Curves (p logrank <0.001 and <0.001) and a good calibration when comparing predicted and observed results.If validated in future studies, these factors may help to optimize discharge strategies and thus shorten LOS in CAP patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland.

ABSTRACT

Background: Length of hospital stay (LOS) in patients with community-acquired pneumonia (CAP) is variable and directly related to medical costs. Accurate estimation of LOS on admission and during follow-up may result in earlier and more efficient discharge strategies.

Methods: This is a prospective multicenter study including patients in emergency departments of 6 tertiary care hospitals in Switzerland between October 2006 and March 2008. Medical history, clinical data at presentation and health care insurance class were collected. We calculated univariate and multivariate cox regression models to assess the association of different characteristics with LOS. In a split sample analysis, we created two LOS prediction rules, first including only admission data, and second including also additional inpatient information.

Results: The mean LOS in the 875 included CAP patients was 9.8 days (95%CI 9.3-10.4). Older age, respiratory rate >20 pm, nursing home residence, chronic pulmonary disease, diabetes, multilobar CAP and the pneumonia severity index class were independently associated with longer LOS in the admission prediction model. When also considering follow-up information, low albumin levels, ICU transfer and development of CAP-associated complications were additional independent risk factors for prolonged LOS. Both weighted clinical prediction rules based on these factors showed a high separation of patients in Kaplan Meier Curves (p logrank <0.001 and <0.001) and a good calibration when comparing predicted and observed results.

Conclusions: Within this study we identified different baseline and follow-up characteristics to be strong and independent predictors for LOS. If validated in future studies, these factors may help to optimize discharge strategies and thus shorten LOS in CAP patients.

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Related in: MedlinePlus

Association of factors present on hospital admission and duration of hospital stay. Points refer to a weighted-risk score based on age (3 points), high respiratory rate >20 pm (1 point), being a nursing home resident or need for regular outpatient nursing assistance at home (1 point), chronic pulmonary disease (1 point) and congestive heart failure (1 point) and multilobar CAP (1 point).
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Figure 1: Association of factors present on hospital admission and duration of hospital stay. Points refer to a weighted-risk score based on age (3 points), high respiratory rate >20 pm (1 point), being a nursing home resident or need for regular outpatient nursing assistance at home (1 point), chronic pulmonary disease (1 point) and congestive heart failure (1 point) and multilobar CAP (1 point).

Mentions: Using a 50:50 split sample analysis approach, we calculated two multivariate prediction models: one for factors being present on hospital admission only, and one with all factors on admission and during hospital stay (Table 3). In the admission only model, older age, respiratory rate >20 pm, nursing home residence, chronic pulmonary disease, diabetes, multilobar CAP and the pneumonia severity index class were independently associated with longer LOS. We calculated a weighted prediction score assigning points based on the magnitude of association. This was also confirmed in Kaplan Meier curves for time to hospital discharge, where more points were associated with significantly longer time until hospital discharge (p logrank <0.001) (Figure 1). This prediction rule also showed a good calibration when used in the validation cohort (Figure 2).


Predictors for length of hospital stay in patients with community-acquired pneumonia: results from a Swiss multicenter study.

Suter-Widmer I, Christ-Crain M, Zimmerli W, Albrich W, Mueller B, Schuetz P, ProHOSP Study Gro - BMC Pulm Med (2012)

Association of factors present on hospital admission and duration of hospital stay. Points refer to a weighted-risk score based on age (3 points), high respiratory rate >20 pm (1 point), being a nursing home resident or need for regular outpatient nursing assistance at home (1 point), chronic pulmonary disease (1 point) and congestive heart failure (1 point) and multilobar CAP (1 point).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475050&req=5

Figure 1: Association of factors present on hospital admission and duration of hospital stay. Points refer to a weighted-risk score based on age (3 points), high respiratory rate >20 pm (1 point), being a nursing home resident or need for regular outpatient nursing assistance at home (1 point), chronic pulmonary disease (1 point) and congestive heart failure (1 point) and multilobar CAP (1 point).
Mentions: Using a 50:50 split sample analysis approach, we calculated two multivariate prediction models: one for factors being present on hospital admission only, and one with all factors on admission and during hospital stay (Table 3). In the admission only model, older age, respiratory rate >20 pm, nursing home residence, chronic pulmonary disease, diabetes, multilobar CAP and the pneumonia severity index class were independently associated with longer LOS. We calculated a weighted prediction score assigning points based on the magnitude of association. This was also confirmed in Kaplan Meier curves for time to hospital discharge, where more points were associated with significantly longer time until hospital discharge (p logrank <0.001) (Figure 1). This prediction rule also showed a good calibration when used in the validation cohort (Figure 2).

Bottom Line: When also considering follow-up information, low albumin levels, ICU transfer and development of CAP-associated complications were additional independent risk factors for prolonged LOS.Both weighted clinical prediction rules based on these factors showed a high separation of patients in Kaplan Meier Curves (p logrank <0.001 and <0.001) and a good calibration when comparing predicted and observed results.If validated in future studies, these factors may help to optimize discharge strategies and thus shorten LOS in CAP patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland.

ABSTRACT

Background: Length of hospital stay (LOS) in patients with community-acquired pneumonia (CAP) is variable and directly related to medical costs. Accurate estimation of LOS on admission and during follow-up may result in earlier and more efficient discharge strategies.

Methods: This is a prospective multicenter study including patients in emergency departments of 6 tertiary care hospitals in Switzerland between October 2006 and March 2008. Medical history, clinical data at presentation and health care insurance class were collected. We calculated univariate and multivariate cox regression models to assess the association of different characteristics with LOS. In a split sample analysis, we created two LOS prediction rules, first including only admission data, and second including also additional inpatient information.

Results: The mean LOS in the 875 included CAP patients was 9.8 days (95%CI 9.3-10.4). Older age, respiratory rate >20 pm, nursing home residence, chronic pulmonary disease, diabetes, multilobar CAP and the pneumonia severity index class were independently associated with longer LOS in the admission prediction model. When also considering follow-up information, low albumin levels, ICU transfer and development of CAP-associated complications were additional independent risk factors for prolonged LOS. Both weighted clinical prediction rules based on these factors showed a high separation of patients in Kaplan Meier Curves (p logrank <0.001 and <0.001) and a good calibration when comparing predicted and observed results.

Conclusions: Within this study we identified different baseline and follow-up characteristics to be strong and independent predictors for LOS. If validated in future studies, these factors may help to optimize discharge strategies and thus shorten LOS in CAP patients.

Show MeSH
Related in: MedlinePlus