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

TY - JOUR

T1 - Associations between biomarkers at discharge and co-morbidities and risk of readmission after community-acquired pneumonia

T2 - a retrospective cohort study

AU - Petersen, Pelle Trier

AU - Egelund, Gertrud Baunbæk

AU - Jensen, Andreas Vestergaard

AU - Andersen, Stine Bang

AU - Pedersen, Merete Frejstrup

AU - Rohde, Gernot

AU - Ravn, Pernille

PY - 2018/6/1

Y1 - 2018/6/1

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.

KW - Aged

KW - Aged, 80 and over

KW - Biomarkers/analysis

KW - Blood Cell Count

KW - C-Reactive Protein/analysis

KW - Cohort Studies

KW - Community-Acquired Infections/diagnosis

KW - Female

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

U2 - 10.1007/s10096-018-3224-8

DO - 10.1007/s10096-018-3224-8

M3 - Journal article

C2 - 29600325

SN - 0934-9723

VL - 37

SP - 1103

EP - 1111

JO - European Journal of Clinical Microbiology & Infectious Diseases

JF - European Journal of Clinical Microbiology & Infectious Diseases

IS - 6

ER -