scholarly journals Limited Effect of Rehabilitation for Preventing a Decline in Functional Status after Community-Acquired Pneumonia in Elderly Patients

2020 ◽  
Author(s):  
Hao Chen ◽  
Yu Hara ◽  
Nobuyuki Horita ◽  
Yusuke Saigusa ◽  
Yoshihiro Hirai ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Functional Status ◽  
Propensity Score Analysis ◽  
Pneumonia Severity Index ◽  
Length Of Hospital Stay ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
High Rate ◽  
Limited Effect ◽  
Factors Affecting

Abstract Background: Functional status is often decreased after hospitalization in elderly community-acquired pneumonia (CAP) survivors. This study investigated factors contributing to decreased functional status.Methods: This retrospective, observational study was conducted in two medical facilities from January 2016 to December 2018. Hospitalized CAP patients >64 years of age were divided into two groups: a maintained group, without decreased functional status, and a decreased group, with decreased functional status. Functional status was evaluated by the Barthel Index (BI) (range, 0–100, in 5-point increments) and graded into three categories: independent, BI 80–100; semi-dependent, BI 30–75; and dependent, BI 0–25. A decreased functional status was considered as a decline of at least one category. The primary outcome was the length of hospital stay. Results: The maintained group included 400 patients, and the decreased group included 138 patients (median age: 77 vs 82 years; p < 0.001). The decreased group had a longer hospital stay (13 vs 27; p<0.001), with a high rate of rehabilitation [189(47.3%) vs 104(75.4%); p<0.001]. Multivariable regression analysis showed that factors affecting functional status were length of hospital stay, aspiration, age, and pneumonia severity index (PSI) category V (odds ratio 1.05, 95%CI 1.04–1.07; 2.66, 95%CI 1.58–4.49; 1.05, 95%CI 1.02–1.09; and 1.92, 95%CI 1.29-3.44; respectively). Rehabilitation showed a limited effect in preventing a decreased functional status on propensity score analysis (p=0.327).Conclusions: Length of hospital stay, aspiration, age, and PSI V were independent contributors to decreased functional status. Rehabilitation showed a limited effect in preventing decreased functional status.

scholarly journals Limited effect of rehabilitation for preventing a decrease in functional status after community-acquired pneumonia in elderly patients 

2020 ◽  
Author(s):  
Hao Chen ◽  
Yu Hara ◽  
Nobuyuki Horita ◽  
Yusuke Saigusa ◽  
Yoshihiro Hirai ◽  
...  
Keyword(s):  
Functional Status ◽  
Propensity Score Analysis ◽  
Multivariable Analysis ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Limited Effect ◽  
Factors Affecting ◽  
Score Analysis ◽  
Medical Facilities

Abstract Background: Functional status (FS) is often decreased after hospitalization in elderly community-acquired pneumonia (CAP) survivors. Rehabilitation has frequently been used to prevent decreased FS. This study was designed to evaluate the effect of rehabilitation for preventing decreased FS.Methods: This retrospective, observational study was conducted in two medical facilities from January 2016 to December 2018, and hospitalized CAP patients >64 years of age were enrolled. FS was assessed by the Barthel Index (BI) (range, 0–100, in 5-point increments) at admission and before discharge and graded into three categories: independent, BI 80–100; semi-dependent, BI 30–75; and dependent, BI 0–25. Multivariable analysis of factors contributing to decreased FS was conducted with two groups: with a decrease of at least one category (decreased group), or without a decrease of a category (maintained group). Then, the effect of rehabilitation was examined by propensity score analysis by adjusting factors contributing to decreased FS determined in the previous multivariable analysis. Results: The maintained group included 400 patients, and the decreased group included 138 patients. The decreased group had a high frequency of rehabilitation therapy (189 (47.3%) vs 104 (75.4%); p<0.001). Multivariable analysis showed that factors affecting FS were length of stay, aspiration pneumonia, age, and Pneumonia Severity Index (PSI) of category V (odds ratio 1.05, 95%CI 1.04–1.07; 2.66, 95%CI 1.58–4.49; 1.05, 95%CI 1.02–1.09; and 1.92, 95%CI 1.29-3.44; respectively). After adjusting for factors contributing to decreased FS, rehabilitation showed a limited effect in preventing a decreased FS in 166 matched pairs (p=0.327).Conclusions: The effect of rehabilitation was still unclear in CAP, and further research is warranted to find an effective way to conduct rehabilitation.

scholarly journals Factors influencing length of hospital stay in community-acquired pneumonia: a study in 27 community hospitals

2004 ◽  
Vol 132 (5) ◽  
pp. 821-829 ◽  
Author(s):  
M. CABRE ◽  
I. BOLIVAR ◽  
G. PERA ◽  
R. PALLARES
Keyword(s):  
Hospital Stay ◽  
Pneumonia Severity Index ◽  
Length Of Hospital Stay ◽  
Severity Index ◽  
Multiple Regression Model ◽  
Community Acquired Pneumonia ◽  
Community Hospitals ◽  
Post Discharge ◽  
Readmission Rates ◽  
Risk Class

We did a retrospective study of 1920 episodes of community-acquired pneumonia (CAP) in 27 community hospitals and analysed inter-hospital variability in length of hospital stay (LOS), mortality and readmission rates. The overall adjusted LOS (mean±S.D.) was 10·0±9·8 days. LOS increased according to the Pneumonia Severity Index (PSI) risk class: 7·3 days for class I to 11·3 days for class V (P<0·001). In a multiple regression model, LOS increased (P<0·001) according to the hospital (inter-hospital variability), PSI risk class, complications during hospitalization, admission to ICU, need of oxygen and transfer to a nursing home. Hospitals with shorter LOS did not show an increased readmission rate (adjusted OR 1·02, 95% CI 0·51–2·03, P=0·97) and post-discharge mortality (adjusted OR 1·20, 95% CI 0·70–2·05, P=0·51). There are significant inter-hospital variations in LOS in patients with CAP which are related to differences in clinical management. The reduction of these differences will further improve efficiency and quality of care.

scholarly journals Azithromycin combination therapy for community-acquired pneumonia: propensity score analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Akihiro Ito ◽  
Tadashi Ishida ◽  
Hiromasa Tachibana ◽  
Hironobu Tokumasu ◽  
Akio Yamazaki ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Propensity Score Analysis ◽  
Pneumonia Severity Index ◽  
Severe Pneumonia ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Combination Group ◽  
Pneumonia Severity ◽  
Score Analysis ◽  
Severe Community Acquired Pneumonia

AbstractWhether macrolide combination therapy reduces the mortality of patients with severe community-acquired pneumonia (CAP) hospitalized in the non-intensive care unit (ICU) remains unclear. Therefore, we investigated the efficacy of adding azithromycin to β-lactam antibiotics for such patients. This prospective cohort study enrolled consecutive patients with CAP hospitalized in the non-ICU between October 2010 and November 2016. The 30-day mortality between β-lactam and azithromycin combination therapy and β-lactam monotherapy was compared in patients classified as mild to moderate and severe according to the CURB-65, Pneumonia Severity Index (PSI), and Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) criteria. Inverse probability of treatment weighting (IPTW) analysis was used to reduce biases. Based on the CURB-65 and PSI, combination therapy did not significantly reduce the 30-day mortality in either group (179 patients in the combination group, 952 in the monotherapy group). However, based on the IDSA/ATS criteria, combination therapy significantly reduced the 30-day mortality in patients with severe (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.007–0.57), but not non-severe pneumonia (OR 1.85, 95% CI 0.51–5.40); these results were similar after IPTW analysis. Azithromycin combination therapy significantly reduced the mortality of patients with severe CAP who met the IDSA/ATS criteria.

Soluble form of suppression of tumorigenicity-2 predicts clinical stability of inpatients with community-acquired pneumonia

2021 ◽  
pp. 153537022110271
Author(s):  
Yifeng Zeng ◽  
Mingshan Xue ◽  
Teng Zhang ◽  
Shixue Sun ◽  
Runpei Lin ◽  
...  
Keyword(s):  
Regression Model ◽  
Predictive Value ◽  
Cox Regression ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Risk Classification ◽  
Soluble Form ◽  
Pneumonia Severity ◽  
Clinical Stability

The soluble form of the suppression of tumorigenicity-2 (sST2) is a biomarker for risk classification and prognosis of heart failure, and its production and secretion in the alveolar epithelium are significantly correlated with the inflammation-inducing in pulmonary diseases. However, the predictive value of sST2 in pulmonary disease had not been widely studied. This study investigated the potential value in prognosis and risk classification of sST2 in patients with community-acquired pneumonia. Clinical data of ninety-three CAP inpatients were retrieved and their sST2 and other clinical indices were studied. Cox regression models were constructed to probe the sST2’s predictive value for patients’ restoring clinical stability and its additive effect on pneumonia severity index and CURB-65 scores. Patients who did not reach clinical stability within the defined time (30 days from hospitalization) have had significantly higher levels of sST2 at admission ( P <  0.05). In univariate and multivariate Cox regression analysis, a high sST2 level (≥72.8 ng/mL) was an independent reverse predictor of clinical stability ( P < 0.05). The Cox regression model combined with sST2 and CURB-65 (AUC: 0.96) provided a more accurate risk classification than CURB-65 (AUC:0.89) alone (NRI: 1.18, IDI: 0.16, P < 0.05). The Cox regression model combined with sST2 and pneumonia severity index (AUC: 0.96) also provided a more accurate risk classification than pneumonia severity index (AUC:0.93) alone (NRI: 0.06; IDI: 0.06, P < 0.05). sST2 at admission can be used as an independent early prognostic indicator for CAP patients. Moreover, it can improve the predictive power of CURB-65 and pneumonia severity index score.

scholarly journals What are the Most Effective Factors in Determining Future Exacerbations, Morbidity Weight and Mortality In Patients Hospitalized wıth COPD Attack? A Prospective Study

2021 ◽  
Author(s):  
Çağla Koç ◽  
Füsun Şahin
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Blood Gases ◽  
Distribution Width ◽  
Factors Affecting ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Arterial Blood ◽  
Gold Stage ◽  
A Prospective Study

INTRODUCTION: The aim of this study was to investigate the important factors affecting the COPD prognosis. MATERIAL AND METHODS: We included 160 hospitalized patients with COPD exacerbation in the study. Hemoglobin-HB, hematocrit-HCT, leukocyte, red cell distribution width- RDW, mean platelet volume, platelet distribution width, plateletcrit, platelet, neutrophil / lymphocyte ratio, platelet / lymphocyte ratio, eosinophil, uric acid, albumin, CRP, procalcitonin, arterial blood gases (PO2, PCO2) pulmonary function test (FEV1, FVC), echocardiography (ejection fraction-EF) GOLD stage, MMRC and BORG scales, Charlson comorbidity index, body mass index-BMI, length of hospital stay were examined on the first day of hospitalization. Admission to the hospital with a new attack, hospitalization in the intensive care unit-ICU, and mortality during the 6 months after discharge were evaluated. RESULTS: High CRP and procalcitonin values were observed in the group with long hospital stay. In mortality group, HB, HCT, BMI and PO2 values were significantly lower than the group without mortality while age and GOLD stage were higher. The age, BORG and MMRC scores, number of exacerbations experienced in the previous 1 year, RDW, eosinophil count, PCO2 were significantly higher in the ICU group than without ICU. HCT, EF values were lower in the ICU group than without ICU. FEV1, FVC values were significantly lower in follow-up attack group than without attack; the duration of COPD and the number of experienced in the previous 1 year were high. CONCLUSION: It has been concluded that the scoring combining selected biomarkers and other factors will be stronger in determining the prognosis.

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