Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort study

Pelle Trier Petersen; Gertrud Baunbæk Egelund; Andreas Vestergaard Jensen; Stine Bang Andersen; Merete Frejstrup Pedersen; Gernot Rohde; Pernille Ravn

doi:10.1007/s10096-018-3224-8

Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort study

Pelle Trier Petersen, Gertrud Baunbæk Egelund, Andreas Vestergaard Jensen, Stine Bang Andersen, Merete Frejstrup Pedersen, Gernot Rohde, Pernille Ravn

Institut for Klinisk Medicin

4 Citationer (Scopus)

30 Downloads (Pure)

Abstract

To investigate whether hemoglobin, white blood cell count (WBC), urea, sodium, albumin, and C-reactive protein at discharge in patients hospitalized for community-acquired pneumonia (CAP) are associated with 30-day readmission. This study is a retrospective cohort study, which included all adult patients discharged after hospitalization for CAP from three Danish hospitals between January 2011 and July 2012. The outcome was all-cause, unplanned, 30-day readmission. Biomarker concentrations at discharge were transformed into binary variables by using either upper or lower quartiles as cut-off; the upper quartile was used for WBC, urea, and C-reactive protein, and the lower quartile was used for hemoglobin, sodium, and albumin. The study population consisted of 1149 patients. One hundred eighty-four (16.0%) patients were readmitted. Independent risk factors of readmission were WBC ≥ 10.6 cells × 10⁹/L (hazard ratio 1.50; 95% CI, 1.07–2.11) and albumin <32 g/L (hazard ratio 1.78; 95% CI, 1.24–2.54) at discharge and the presence of ≥ 2 co-morbidities (hazard ratio 1.74; 95% CI, 1.15–2.64). When WBC, albumin, and co-morbidities were combined into a risk-stratification tool, there was a step-wise increase in risk of readmission for patients with 1, 2, or 3 risk factors with hazard ratios of 1.76 (95% CI, 1.25–2.49), 2.59 (95% CI, 1.71–3.93), and 6.15 (95% CI 3.33–11.38), respectively. WBC ≥ 10.6 cells × 10⁹/L and albumin < 32 g/L at discharge and the presence of ≥ 2 co-morbidities were independently associated with increased risk of 30-day readmission.

Originalsprog	Engelsk
Tidsskrift	European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
Vol/bind	37
Udgave nummer	6
Sider (fra-til)	1103-1111
Antal sider	9
ISSN	0934-9723
DOI	https://doi.org/10.1007/s10096-018-3224-8
Status	Udgivet - 1 jun. 2018

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10.1007/s10096-018-3224-8Licens: CC BY

Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort studyForlagets udgivne version, 713 KBLicens: CC BY

Citationsformater

Petersen, P. T., Egelund, G. B., Jensen, A. V., Andersen, S. B., Pedersen, M. F., Rohde, G., & Ravn, P. (2018). Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort study. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 37(6), 1103-1111. https://doi.org/10.1007/s10096-018-3224-8

Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia : a retrospective cohort study. / Petersen, Pelle Trier; Egelund, Gertrud Baunbæk; Jensen, Andreas Vestergaard et al.

I: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, Bind 37, Nr. 6, 01.06.2018, s. 1103-1111.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Petersen, PT, Egelund, GB, Jensen, AV, Andersen, SB, Pedersen, MF, Rohde, G & Ravn, P 2018, 'Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort study', European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, bind 37, nr. 6, s. 1103-1111. https://doi.org/10.1007/s10096-018-3224-8

Petersen PT, Egelund GB, Jensen AV, Andersen SB, Pedersen MF, Rohde G et al. Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort study. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2018 jun. 1;37(6):1103-1111. doi: 10.1007/s10096-018-3224-8

Petersen, Pelle Trier ; Egelund, Gertrud Baunbæk ; Jensen, Andreas Vestergaard et al. / Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia : a retrospective cohort study. I: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2018 ; Bind 37, Nr. 6. s. 1103-1111.

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abstract = "To investigate whether hemoglobin, white blood cell count (WBC), urea, sodium, albumin, and C-reactive protein at discharge in patients hospitalized for community-acquired pneumonia (CAP) are associated with 30-day readmission. This study is a retrospective cohort study, which included all adult patients discharged after hospitalization for CAP from three Danish hospitals between January 2011 and July 2012. The outcome was all-cause, unplanned, 30-day readmission. Biomarker concentrations at discharge were transformed into binary variables by using either upper or lower quartiles as cut-off; the upper quartile was used for WBC, urea, and C-reactive protein, and the lower quartile was used for hemoglobin, sodium, and albumin. The study population consisted of 1149 patients. One hundred eighty-four (16.0%) patients were readmitted. Independent risk factors of readmission were WBC ≥ 10.6 cells × 109/L (hazard ratio 1.50; 95% CI, 1.07–2.11) and albumin <32 g/L (hazard ratio 1.78; 95% CI, 1.24–2.54) at discharge and the presence of ≥ 2 co-morbidities (hazard ratio 1.74; 95% CI, 1.15–2.64). When WBC, albumin, and co-morbidities were combined into a risk-stratification tool, there was a step-wise increase in risk of readmission for patients with 1, 2, or 3 risk factors with hazard ratios of 1.76 (95% CI, 1.25–2.49), 2.59 (95% CI, 1.71–3.93), and 6.15 (95% CI 3.33–11.38), respectively. WBC ≥ 10.6 cells × 109/L and albumin < 32 g/L at discharge and the presence of ≥ 2 co-morbidities were independently associated with increased risk of 30-day readmission.",

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AU - Petersen, Pelle Trier

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AU - Jensen, Andreas Vestergaard

AU - Andersen, Stine Bang

AU - Pedersen, Merete Frejstrup

AU - Rohde, Gernot

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N2 - To investigate whether hemoglobin, white blood cell count (WBC), urea, sodium, albumin, and C-reactive protein at discharge in patients hospitalized for community-acquired pneumonia (CAP) are associated with 30-day readmission. This study is a retrospective cohort study, which included all adult patients discharged after hospitalization for CAP from three Danish hospitals between January 2011 and July 2012. The outcome was all-cause, unplanned, 30-day readmission. Biomarker concentrations at discharge were transformed into binary variables by using either upper or lower quartiles as cut-off; the upper quartile was used for WBC, urea, and C-reactive protein, and the lower quartile was used for hemoglobin, sodium, and albumin. The study population consisted of 1149 patients. One hundred eighty-four (16.0%) patients were readmitted. Independent risk factors of readmission were WBC ≥ 10.6 cells × 109/L (hazard ratio 1.50; 95% CI, 1.07–2.11) and albumin <32 g/L (hazard ratio 1.78; 95% CI, 1.24–2.54) at discharge and the presence of ≥ 2 co-morbidities (hazard ratio 1.74; 95% CI, 1.15–2.64). When WBC, albumin, and co-morbidities were combined into a risk-stratification tool, there was a step-wise increase in risk of readmission for patients with 1, 2, or 3 risk factors with hazard ratios of 1.76 (95% CI, 1.25–2.49), 2.59 (95% CI, 1.71–3.93), and 6.15 (95% CI 3.33–11.38), respectively. WBC ≥ 10.6 cells × 109/L and albumin < 32 g/L at discharge and the presence of ≥ 2 co-morbidities were independently associated with increased risk of 30-day readmission.

AB - To investigate whether hemoglobin, white blood cell count (WBC), urea, sodium, albumin, and C-reactive protein at discharge in patients hospitalized for community-acquired pneumonia (CAP) are associated with 30-day readmission. This study is a retrospective cohort study, which included all adult patients discharged after hospitalization for CAP from three Danish hospitals between January 2011 and July 2012. The outcome was all-cause, unplanned, 30-day readmission. Biomarker concentrations at discharge were transformed into binary variables by using either upper or lower quartiles as cut-off; the upper quartile was used for WBC, urea, and C-reactive protein, and the lower quartile was used for hemoglobin, sodium, and albumin. The study population consisted of 1149 patients. One hundred eighty-four (16.0%) patients were readmitted. Independent risk factors of readmission were WBC ≥ 10.6 cells × 109/L (hazard ratio 1.50; 95% CI, 1.07–2.11) and albumin <32 g/L (hazard ratio 1.78; 95% CI, 1.24–2.54) at discharge and the presence of ≥ 2 co-morbidities (hazard ratio 1.74; 95% CI, 1.15–2.64). When WBC, albumin, and co-morbidities were combined into a risk-stratification tool, there was a step-wise increase in risk of readmission for patients with 1, 2, or 3 risk factors with hazard ratios of 1.76 (95% CI, 1.25–2.49), 2.59 (95% CI, 1.71–3.93), and 6.15 (95% CI 3.33–11.38), respectively. WBC ≥ 10.6 cells × 109/L and albumin < 32 g/L at discharge and the presence of ≥ 2 co-morbidities were independently associated with increased risk of 30-day readmission.

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KW - Community-Acquired Infections/diagnosis

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KW - Hospitalization

KW - Humans

KW - Male

KW - Middle Aged

KW - Patient Discharge

KW - Patient Outcome Assessment

KW - Patient Readmission

KW - Pneumonia/diagnosis

KW - Retrospective Studies

KW - Serum Albumin/analysis

KW - Urea/analysis

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DO - 10.1007/s10096-018-3224-8

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VL - 37

SP - 1103

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JO - European Journal of Clinical Microbiology & Infectious Diseases

JF - European Journal of Clinical Microbiology & Infectious Diseases

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ER -

Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia: a retrospective cohort study

Abstract

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