title: Physiological and biological predictors of length of stay and recovery in adults with acute asthma: An observational cohort study.
abstract: BACKGROUND
  Asthma is a prevalent, chronic disease associated with significant risk to patients and cost to healthcare systems. Accurate estimates of length of stay and recovery are important for patient information, physician prognostication, and management of inpatient beds.
  
  
  OBJECTIVE
  To assess factors affecting length of stay and time to recovery in adults with acute asthma.
  
  
  METHODS
  We prospectively recruited adult asthmatic non-smokers admitted with an asthma exacerbation. Participants were assessed for demographics, symptoms, medications, bloods including blood count, clotting status, and cytokines. Results were analyzed for correlation and subsequently in a regression model.
  
  
  RESULTS
  One hundred twenty-six participants were recruited of which 75.4% were female. Mean age was 40.0 and mean length of stay was 3.98 days. Length of stay was associated with lower APTT ratio (<P = 0.001), oxygen requirement (P = 0.02), increased AST (P = 0.005), increasing age (P = 0.02), and lower %predicted FEV1 (P = 0.02). Longer time to recovery was associated with plasma IL-12 >1 pg/mL (P = 0.04).
  
  
  CONCLUSIONS
  Older participants with lower FEV1 and supplemental oxygen requirements are likely to remain in hospital longer. Activation of the "intrinsic" clotting pathway correlates with an increased length of stay as does a raised serum AST. Detectable IL-12 in plasma correlates with slower recovery and this may be due to poor response to corticosteroids.
authors.affiliation: Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.|School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Jones
authors.affiliation: School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.|Hampshire Hospitals NHS Foundation Trust, Hampshire, England.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Owen
authors.affiliation: Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.|School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
authors.forename: Scott
authors.initials: S
authors.lastname: Elliott
authors.affiliation: Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.|School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Brown
authors.affiliation: Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.|School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
authors.forename: Dominic
authors.initials: D
authors.lastname: Reynish
authors.affiliation: Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.
authors.forename: Heena
authors.initials: H
authors.lastname: Mistry
authors.affiliation: Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.
authors.forename: Sumita
authors.initials: S
authors.lastname: Kerley
authors.affiliation: Hampshire Hospitals NHS Foundation Trust, Hampshire, England.
authors.forename: Salah
authors.initials: S
authors.lastname: Matti
authors.affiliation: School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
authors.forename: Janis K
authors.initials: JK
authors.lastname: Shute
authors.affiliation: Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.|School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, United Kingdom.
authors.forename: Anoop J
authors.initials: AJ
authors.lastname: Chauhan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005540:Forced Expiratory Flow Rates / Q000502:physiology*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D055815:Young Adult
chemical_list: D015415:Biomarkers; D016207:Cytokines
keywords: asthma; cytokines; hospitalization; inpatients; interleukin-12; length of stay