scholarly journals Impact of a Clinical Pathway for Hospital Management of Community-Acquired Pneumonia: A Retrospective Cohort Study

2021 ◽  
pp. 450-459
Author(s):  
Barchín JL ◽  
Wikman-Jorgensen PE ◽  
Bello L ◽  
Pascual R
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Clinical Pathway ◽  
Retrospective Cohort ◽  
Clinical Pathways ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Community Acquired Pneumonia ◽  
Primary Objective

Introduction: Community-acquired pneumonia is a prevalent disease that is managed in heterogeneous ways. Clinical pathways have been proposed as one way to mitigate this variability, but few implementation experiences have been published. The primary objective of this study is to analyse the effects of implementing a standardised clinical pathway for community-acquired pneumonia on length of hospital stay. Methods: Retrospective cohort study comparing two equivalent time periods with and without a clinical pathway. We described patient characteristics in both periods and compared mean length of hospital stay, mortality, rate of complications, and readmissions within 30 days. Results: A total of 170 patients were included across both periods. Mean length of hospital stay in patients treated before implementation of the clinical pathway was 6.05 days versus 5.43 days afterward (p = 0.28). The segmented regression analysis showed a change in slope for the length of hospital stay (0.04) following implementation of the clinical pathway. The proportion of patients hospitalised for more than 6 days was 37.5% in the first period, compared to 29.6% in the second (p = 0.088). Multivariable analysis showed that nonadherence to the clinical pathway was associated with a hospital stay of longer than 6 days (p = 0.048). Mortality dropped from 10.5% to 4.7% after the clinical pathway was established (p = 0.12). The proportion of patients readmitted within 30 days due to CAP was 8.8% before the establishment of the clinical pathway and 0% afterwards (p = 0.006). Conclusion: A clinical pathway for managing community-acquired pneumonia was associated with a reduction in length of hospital stay and readmittance. There was a trend towards mortality reduction.

scholarly journals A Nomogram Prediction of Length of Hospital Stay in Patients with COVID-19 Pneumonia: A Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Kang Li ◽  
Chi Zhang ◽  
Ling Qin ◽  
Chaoran Zang ◽  
Ang Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Proportional Hazards ◽  
Characteristic Curve ◽  
Length Of Hospital Stay ◽  
Cox Proportional Hazards ◽  
Brier Score ◽  
Rank Test

Assessing the length of hospital stay (LOS) in patients with coronavirus disease 2019 (COVID-19) pneumonia is helpful in optimizing the use efficiency of hospital beds and medical resources and relieving medical resource shortages. This retrospective cohort study of 97 patients was conducted at Beijing You’An Hospital between January 21, 2020, and March 21, 2020. A multivariate Cox proportional hazards regression based on the smallest Akaike information criterion value was used to select demographic and clinical variables to construct a nomogram. Discrimination, area under the receiver operating characteristic curve (AUC), calibration, and Kaplan–Meier curves with the log-rank test were used to assess the nomogram model. The median LOS was 13 days (interquartile range [IQR]: 10–18). Age, alanine aminotransferase, pneumonia, platelet count, and PF ratio (PaO2/FiO2) were included in the final model. The C-index of the nomogram was 0.76 ( 95 % confidence   interval   CI = 0.69 – 0.83 ), and the AUC was 0.88 ( 95 % CI = 0.82 – 0.95 ). The adjusted C-index was 0.75 ( 95 % CI = 0.67 – 0.82 ) and adjusted AUC 0.86 ( 95 % CI = 0.73 – 0.95 ), both after 1000 bootstrap cross internal validations. A Brier score of 0.11 ( 95 % CI = 0.07 – 0.15 ) and adjusted Brier score of 0.130 ( 95 % CI = 0.07 – 0.20 ) for the calibration curve showed good agreement. The AUC values for the nomogram at LOS of 10, 20, and 30 days were 0.79 ( 95 % CI = 0.69 – 0.89 ), 0.89 ( 95 % CI = 0.83 – 0.96 ), and 0.96 ( 95 % CI = 0.92 – 1.00 ), respectively, and the high fit score of the nomogram model indicated a high probability of hospital stay. These results confirmed that the nomogram model accurately predicted the LOS of patients with COVID-19. We developed and validated a nomogram that incorporated five independent predictors of LOS. If validated in a future large cohort study, the model may help to optimize discharge strategies and, thus, shorten LOS in patients with COVID-19.

scholarly journals Intravenous immunoglobulin-based adjuvant therapy for severe COVID-19: a single-center retrospective cohort study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Xiao Hou ◽  
Li Tian ◽  
Lei Zhou ◽  
Xinhua Jia ◽  
Li Kong ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cohort Study ◽  
Adjuvant Therapy ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Intravenous Immunoglobulin ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Length Of Hospital Stay ◽  
Single Center

Abstract Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines issued by National Health Commission of the People's Repubilic of China recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG. Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay. Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared to the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P = 0.008] and had longer hospital stay periods [23.0 (19.0–31.0) vs 16.0 (13.8–22.0), P < 0.001]. After adjusting for confounding factors, differences in primary outcomes between the two groups were not statistically significant (P = 0.167), however, patients in the IVIG group had longer hospital stay periods (P = 0.041). Conclusion Adjuvant therapy with IVIG did not improve in-hospital mortality rates or the need for mechanical ventilation in severe COVID-19 patients. Our study does not support the use of immunoglobulin in patients with severe COVID-19 patients.

scholarly journals Serum 8-iso-PGF2α Predicts the Severity and Prognosis in Patients With Community-Acquired Pneumonia: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Ling Zheng ◽  
Jun Fei ◽  
Chun-Mei Feng ◽  
Zheng Xu ◽  
Lin Fu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Inflammatory Cytokines ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Elevated Serum ◽  
Community Acquired Pneumonia ◽  
Risk Of Death ◽  
Severity Scores

Background: Many studies have identified the important role of 8-isoprostane (8-iso-PGF2α) in pulmonary diseases. However, the role of 8-iso-PGF2α in community-acquired pneumonia (CAP) remains unclear. Therefore, the main goal was to investigate the correlations of serum 8-iso-PGF2α with the severity and prognosis in CAP patients through a hospital-based retrospective cohort study.Methods: All 220 patients with CAP were enrolled. Demographic information and clinical data were collected. Levels of 8-iso-PGF2α and inflammatory cytokines were detected in serum using ELISA.Results: The levels of 8-iso-PGF2α were gradually increased in parallel with the CAP severity scores. Univariate and multivariate logistic regression analyses revealed a positive association between serum 8-iso-PGF2α and the CAP severity scores. Additionally, serum 8-iso-PGF2α levels were positively correlated with circulating inflammatory cytokines (CRP and TNFα). Serum 8-iso-PGF2α levels were increased in the patients with a longer hospital stay than those with a shorter hospital stay. Additionally, 20 patients died after hospitalization. Dead patients presented a higher serum 8-iso-PGF2α than surviving patients. A subsequent survival analysis revealed that higher serum 8-iso-PGF2α levels positively correlated with the risk of death in patients with CAP.Conclusions: Serum 8-iso-PGF2α levels on admission are positively associated with the severity of CAP patients. Elevated serum 8-iso-PGF2α on admission prolongs hospital stay and increases the risk of death in patients with CAP, indicating that 8-iso-PGF2α may be involved in the progression of CAP and serve as an early serum prognostic biomarker for CAP.

scholarly journals The Associations of Serum IL-37 With the Severity and Prognosis in Patients With Community-Acquired Pneumonia: A Retrospective Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia-Le Wang ◽  
Xue Chen ◽  
Yi Xu ◽  
Yue-Xin Chen ◽  
Jing Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Community Acquired Pneumonia ◽  
Predictive Capacity ◽  
Correlative Analysis ◽  
Diagnosis And Prognosis ◽  
Severity Scores

BackgroundRecent evidences suggested that IL-37 may participate in the pathophysiology of community-acquired pneumonia (CAP). Nevertheless, its exact biological role was unknown. The objective of this study was to determine the associations of serum IL-37 with the severity and prognosis in CAP patients based on a retrospective cohort study.MethodsThe whole of 120 healthy subjects and 240 CAP patients were summoned. Peripheral blood was collected and IL-37 was detected using ELISA.ResultsSerum IL-37 was obviously decreased in CAP patients on admission. In addition, serum IL-37 was gradually decreased in parallel with CAP severity scores. Correlative analysis revealed that serum IL-37 was negatively associated with CAP severity scores and inflammatory cytokines. Further logistical regression found that reduction of serum IL-37 augmented the severity of CAP patients. Moreover, the follow-up research was performed in CAP patients. Serum lower IL-37 on admission prolonged the hospital stay in CAP patients. Serum IL-37 combination with PSI and CURB-65 had a stronger predictive capacity for death than IL-37 and CAP severity score alone in CAP patients.ConclusionThere are remarkably negative correlations between serum IL-37 with the severity and prognosis in CAP patients. Serum IL-37 on admission prolongs the hospital stay, demonstrating that IL-37 may involve in the process of CAP. Serum IL-37 may be regarded as a biomarker for diagnosis and prognosis for CAP patients.

scholarly journals P-OGC74 Effect of pre-operative anaemia on short-term outcomes following oesophagectomy: a 10-year retrospective cohort study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Siobhan Chien ◽  
Khurram Khan ◽  
Lewis Gall ◽  
Liam Deboys ◽  
Carol Craig ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Length Of Hospital Stay ◽  
Short Term ◽  
Operative Complications ◽  
The Impact ◽  
Post Operative Complications

Abstract Background Pre-operative anaemia is associated with increased length of hospital stay, requirement for allogenic blood transfusion, post-operative complications and mortality. Oesophagectomy is a complex procedure associated with significant physiological insult, thus pre-operative patient optimisation is imperative to improve clinical outcomes. This study aimed to determine the impact of pre-operative anaemia on short-term outcomes following oesophagectomy for benign and malignant disease.  Methods A retrospective cohort study of all oesophagectomies performed in a single tertiary referral centre between 1 January 2010 and 31 December 2019 was performed. Patients were identified from a prospectively collected database and individual patient electronic records were interrogated. Patients were dichotomised into two groups, based on the most recent pre-operative haemoglobin. Patients with pre-operative anaemia (haemoglobin &lt;130mg/L in males and &lt;120mg/L in females) were compared to those without pre-operative anaemia. Patients with missing data were excluded from the study. Patients were followed up for a median of 32 months (IQR 18-66). Results Of 352 patients eligible for inclusion, 173 (49.1%) patients were anaemic immediately pre-operatively. Patients with pre-operative anaemia were older (66 vs. 64 years, p = 0.031), with a lower anaerobic threshold (11.7 vs. 12.3ml/min/kg, p = 0.011), and were significantly more likely to have undergone neoadjuvant chemotherapy (91.3% vs. 78.8%, p &lt; 0.001). Patient comorbidities and disease-related characteristics were similar between the two groups. Patients with pre-operative anaemia were significantly more likely to require post-operative blood transfusion (34.7% vs. 16.8%; p &lt; 0.001). However, pre-operative anaemia was not associated with increased post-operative complications, intensive care admission, length of hospital stay, or 30- and 90-day mortality rates following oesophagectomy. Conclusions Patients with anaemia immediately prior to undergoing an oesophagectomy were significantly more likely to require post-operative blood transfusion. However, pre-operative anaemia was not associated with an increased rate of post-operative morbidity or mortality. In addition, pre-operative iron transfusion is becoming increasingly utilised to minimise the incidence of pre-operative anaemia: this was not analysed in this study.

scholarly journals LACK OF ASSOCIATION BETWEEN CONVALESCENT PLASMA ADMINISTRATION AND LENGTH OF HOSPITAL STAY: A HOSPITAL-DAY STRATIFIED MULTI-CENTER RETROSPECTIVE COHORT STUDY

2021 ◽  
Author(s):  
Joy Alamgir ◽  
Ruhul Abid ◽  
Brian T Garibaldi ◽  
Naved Munir ◽  
Soko Setoguchi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Length Of Hospital Stay ◽  
The United States ◽  
Competing Risk ◽  
Survival Models ◽  
Hospital Death ◽  
Cox's Regression

Background: Effects of timing of Convalescent plasma (CP) administration on hospitalized COVID-19 patients are not established. Methods: We used the National COVID Cohort Collaborative data to perform a retrospective cohort study of hospitalized COVID-19 patients in the United States between 07-01-2020 and 12-19-2020. We stratified patients based on day of CP administration (Day 0, 1, 2, 3 and 4) from COVID-19 diagnosis. We used 35 predictors to frame matched cohorts accounting for clinical and sociodemographic characteristics. We used competing risk survival models to examine the association between CP administration and length of hospital stay with in-hospital death as a competing risk performing Gray's test on the cumulative incidence function and Cox's regression on cause specific hazard ratios. Results: In a cohort of 4,003 hospitalized COVID-19 patients, 197 (4.9%) received CP within the first 5 days following COVID-19 diagnosis. After adjusting for potential confounding variables, there were no statistically significant associations between day of CP administration and length of hospital stay. Day 0 CP administration signallled lower mortality but was not statistically significant (HR 0.45 [0.19-1.03]). Conclusions: We found no association between the timing of CP administration and length of stay among hospitalized COVID-19 patients.

Sign in / Sign up

Export Citation Format

Share Document