Predictors and Implications of Early Clinical Stability in Patients Hospitalized for Moderately Severe Community-Acquired Pneumonia.
BACKGROUND
Assessment of early response to treatment is crucial for the management of community-acquired pneumonia (CAP).


OBJECTIVE
To describe the predictors and the outcomes of early clinical stability.


METHODS
We did a secondary analysis of a multicentre randomized controlled trial on CAP treatment in which 580 patients hospitalized for moderately severe CAP were included. The association between demographic, clinical and biological variables available at inclusion and early clinical stability (stabilization of vital signs within 72 hours with predetermined cut-offs) was assessed by multivariate logistic regression. The association between early clinical stability and mortality, severe adverse events, and length of stay was also tested.


RESULTS
Younger age (OR 0.98, 95% CI 0.96-0.99), lower platelet count (OR per 10 G/L increment 0.96, 95% CI 0.94-0.98), lower respiratory rate (OR 0.94, 95% CI 0.90-0.97), absence of hypoxemia (OR 0.58, 95% CI 0.40-0.85), lower numbers of co-morbid conditions (OR 0.82, 95% CI 0.69-0.98) and signs or symptoms (OR 0.78, 95% CI 0.68-0.90) were significantly associated with early clinical stability. Patients with early clinical stability had lower 90-days mortality (3.4% vs. 11.9%, p<0.001), fewer admissions to the intensive care unit (2.7% vs. 8.0%, p = 0.005) and a shorter length of stay (6.0 days, IQR 4.0-10.0 vs. 10.0 days, IQR 7.0-15.0, p<0.001).


CONCLUSIONS
Patients with younger age, less co-morbidity, fewer signs or symptoms, less respiratory compromise, and a lower platelet count are more likely to reach early clinical stability. Patients without early clinical stability have a worse prognosis and warrant close scrutiny.
Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.|Division of Internal Medicine Regional Hospital Riviera-Chablais, Monthey, Switzerland.
Nicolas
http://orcid.org/0000-0003-4712-6666
N
Garin
Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Garance
G
Felix
Division of Internal Medicine, Hôpital cantonal, Fribourg, Switzerland.
Christian
C
Chuard
Division of Internal Medicine, Centre Hospitalier de Bienne, Bienne, Switzerland.
Daniel
D
Genné
Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Sebastian
S
Carballo
Department of Emergency Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Olivier
O
Hugli
Division of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Olivier
O
Lamy
Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Christophe
C
Marti
Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Mathieu
M
Nendaz
Emergency Department, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Olivier
O
Rutschmann
Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Stephan
S
Harbarth
Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Arnaud
A
Perrier
D000328:Adult; D000367:Age Factors; D000368:Aged; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011014:Pneumonia / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult