title: Association between time to clinical stability and outcomes after discharge in hospitalized patients with community-acquired pneumonia.
abstract: 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.
authors.affiliation: Dipartimento toraco-polmonare e cardio-circolatorio, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: stefano.aliberti@unimib.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY.
authors.forename: Paula
authors.initials: P
authors.lastname: Peyrani
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, TX.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mirsaeidi
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY.
authors.forename: Asad
authors.initials: A
authors.lastname: Amir
authors.affiliation: Dipartimento toraco-polmonare e cardio-circolatorio, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Ramirez
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000401:mortality; D016896:Treatment Outcome