title: Predictors of in-hospital vs postdischarge mortality in pneumonia.
abstract: BACKGROUND
  Many patients who die within 30 days of admission to the hospital for pneumonia die after discharge. Recently, 30-day mortality for patients with pneumonia became a publicly reported performance measure, meaning that hospitals are, in part, being measured based on how the patient fares after discharge from the hospital. This study was undertaken to determine which factors predict in-hospital vs postdischarge mortality in patients with pneumonia.
  
  
  METHODS
  This was a retrospective analysis of a database of 21,223 patients on Medicare aged 65 years and older admitted to the hospital between 2000 and 2001. Multivariate logistic regression analyses were performed to determine the association between 26 patient characteristics and the timing of death (in-hospital vs postdischarge) among those patients who died within 30 days of hospital admission.
  
  
  RESULTS
  Among the 21,223 patients, 2,561 (12.1%) died within 30 days of admission: 1,343 (52.4%) during the hospital stay, and 1,218 (47.6%) after discharge. Multivariate logistic regression demonstrated that seven factors were significantly associated with death prior to discharge: systolic BP < 90 mm Hg, respiration rate > 30/min, bacteremia, arterial pH < 7.35, BUN level > 11 mmol/L, arterial Po(2) < 60 mm Hg or arterial oxygen saturation < 90%, and need for mechanical ventilation. Some underlying comorbidities were associated with a nonstatistically significant trend toward death after discharge.
  
  
  CONCLUSIONS
  Of elderly patients dying within 30 days of admission to the hospital, approximately one-half die after discharge from the hospital. Comorbidities, in general, were equally associated with death in the hospital and death after discharge
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT. Electronic address: Metersky@nso.uchc.edu.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Metersky
authors.affiliation: University of Western Australia, Perth, WA, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Waterer
authors.affiliation: Oklahoma Foundation for Medical Quality, Oklahoma City, OK.
authors.forename: Wato
authors.initials: W
authors.lastname: Nsa
authors.affiliation: Oklahoma Foundation for Medical Quality, Oklahoma City, OK; University of Oklahoma Health Sciences Center, College of Public Health, Oklahoma City, OK.
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014481:United States / Q000453:epidemiology