Pneumonia: criteria for patient instability on hospital discharge.
BACKGROUND
A study was undertaken to identify and weigh at the time of hospital discharge simple clinical variables that could predict short-term outcomes in patients with pneumonia.


METHODS
In a prospective observational cohort study of 870 patients discharged alive after hospitalization for pneumonia, we collected oxygenation and vital signs on discharge and assessed mortality and readmission within 30 days. From the beta-parameter obtained in a multivariate Cox proportional hazard regression model, a score was assigned to each predictive variable. The effects of instability at discharge on outcomes within 30 days thereafter were examined by adjusted models with use of the pneumonia severity index at hospital admission, the length of stay, the Charlson comorbidity index, or the preillness functional status.


RESULTS
Four variables related to a 30-day mortality rate from all causes were identified in the multivariate model; these included one major criterion (temperature >37.5 degrees C) and three minor criteria (systolic BP < 90 mm Hg or diastolic BP < 60 mm Hg, respiratory rate > 24 breaths/min, and oxygen saturation < 90%). The developed score remained significantly associated with a higher risk-adjusted rate of death. Patients with a score > or = 2 (one major criterion or two minor criteria) had a sixfold-greater risk-adjusted hazard ratio (HR) of death (HR, 5.8; 95% confidence interval, 2.5 to 13.1).


CONCLUSIONS
Four criteria of instability on discharge seem to be related to the mortality rate after discharge, but each of the factors must be weighed differently. The resulting score is a simple alternative that can be used by clinicians in the discharge process.
Capelastegui
Alberto
A
Pneumology Service, Hospital de Galdakao-Usansolo-CIBER Epidemiología y Salud Pública, Galdakao. Electronic address: alberto.capelasteguisaiz@osakidetza.net.
España
Pedro P
PP
Pneumology Service, Hospital de Galdakao-Usansolo-CIBER Epidemiología y Salud Pública, Galdakao.
Bilbao
Amaia
A
Basque Foundation for Health Innovation and Research-CIBER Epidemiología y Salud Pública, Sondika, Bizkaia, Spain.
Martinez-Vazquez
Marimar
M
Department of Emergency Medicine, Hospital de Galdakao-Usansolo-CIBER Epidemiología y Salud Pública, Galdakao.
Gorordo
Inmaculada
I
Pneumology Service, Hospital de Galdakao-Usansolo-CIBER Epidemiología y Salud Pública, Galdakao.
Oribe
Mikel
M
Pneumology Service, Hospital de Galdakao-Usansolo-CIBER Epidemiología y Salud Pública, Galdakao.
Urrutia
Isabel
I
Pneumology Service, Hospital de Galdakao-Usansolo-CIBER Epidemiología y Salud Pública, Galdakao.
Quintana
José M
JM
Research Unit, Hospital de Galdakao-Usansolo-CIBER Epidemiología y Salud Pública, Galdakao.
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000592:standards*; D011014:Pneumonia / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate