Early post-discharge mortality in CAP: frequency, risk factors and a prediction tool

Abstract

There are few data on mortality after discharge with community-acquired pneumonia (CAP). Therefore, we evaluated risk factors for 30-day post-discharge mortality after CAP. We included all patients of the prospective multi-national CAPNETZ study between 2002 and 2018 with (1) hospitalized CAP, (2) survival until discharge, and (3) complete follow-up data. The study endpoint was death within 30 days after discharge. We evaluated risk factors including demographics, comorbidities, admission CAP severity, and laboratory values and treatment-related factors in uni- and multivariable analyses. A total of 126 (1.6%) of 7882 included patients died until day 30 after discharge, corresponding to 26% of all 476 deaths. After multivariable analysis, we identified 10 independent risk factors: higher age, lower BMI, presence of diabetes mellitus, chronic renal or chronic neurological disease (other than cerebrovascular diseases), low body temperature or higher thrombocytes on admission, extended length of hospitalization, oxygen therapy during hospitalization, and post-obstructive pneumonia. By addition these factors, we calculated a risk score with an AUC of 0.831 (95%CI 0.822–0.839, p < 0.001) for prediction of post-discharge mortality. Early post-discharge deaths account for ¼ of all CAP-associated deaths and are associated with patient- and CAP-severity-related risk factors. Additional studies are necessary to replicate our findings in independent cohorts. Study registration: NCT 02139163.

Predictors of Length of Stay, Rehospitalization and Mortality in Community-Acquired Pneumonia Patients: A Retrospective Cohort Study

“…The findings from our study reinforce prior observations that all-cause mortality during the year subsequent to hospital admission for pneumonia is linked to increasing age and a worsening comorbidity profile [46,58,59]. A recent study concluded that while long-term mortality following CAP was primarily associated with comorbidities, there is potential for early post-discharge complications (within 30 days) to be attributed to CAP-related issues that may benefit from targeted interventions [60]. However, our results did not find different predictors between the two mortality outcomes.…”

Sterblichkeit nach ambulant erworbener Pneumonie: Wie sich das Risiko abschätzen lässt

“…Zum Sterberisiko früh nach Entlassung aus dem Krankenhausaufenthalt ist bisher wenig bekannt. Glöckner et al 1 beschreiben demografische und klinische Faktoren, anhand derer sich das Sterberisiko innerhalb von 30 Tagen nach Entlassung abschätzen lässt.…”

“…Anhand von 7882 Patienten, die im Zeitraum von 2002–2018 in der CAPNetz-Studie dokumentiert wurden, sind 10 auswertbare Risikofaktoren in einer multivariaten Analyse sichtbar 1 :…”

Ambulant erworbene Pneumonie

“…Diese soll auch dazu dienen, spezielle Therapieansätze zu entwickeln und besondere Risikogruppen zu definieren. Im Rahmen der CAPNETZ-Studie wurden folgende Risikofaktoren für eine erhöhte Letalität innerhalb von 30 Tagen nach Krankenhausentlassung identifiziert [27]:…”