Table 6.
Main risk factors related to readmission in CAP.
| Reference | Type of Study | 30 Days Readmission n (%) |
CAP Related Factors | Non-CAP Related Factors | Commentaries |
|---|---|---|---|---|---|
| Adamuz J, et al. [121] |
Prospective Single centre |
n = 934 (25.5%) |
Worsening signs and symptoms of CAP: 38.9% | CAP non-related: 43% Cardiovascular (16.5%), pulmonary disease (11.1%), Neoplasia (6.9%), other infections (2.8%), Neurologic disease (1.4%), gastrointestinal disease (1.4%), treatment toxicity (1.4%). Admission within the previous 90 days: OR 2.47; (CI 95%: 1.11–5.52) comorbidities: OR 3.99; (CI 95%: 1.12–14.23) |
In 18% it was attributed to the addition of CAP related and non-related |
| Capelastegui, et al. [124] | Prospective Single centre |
n = 1.117(7.3%) | Worsening signs and symptoms of CAP: 35.8% Treatment failure: HR 2.9; CI 95%: 1.2–6.8 Clinical instability at discharge: HR 2.8; CI 95%: 1.3–6.2 Both factors: HR 9.0; CI 95%: 3.2–25.3 |
CAP non-related: 64.2% age ≥ 65: (HR: 4.5; CI 95%: 1.4–14.7) Charlson Comorbidity Score over 2: (HR: 1.9; CI 95%: 1.0–3.4) Both factors: (HR, 5.3; CI del 95%, 1.6 a 18.1) |
A greater number of factors was associated with a higher risk of readmission (p < 0.001). At hospital discharge, patients without risk factors had a probability of readmission of less than 1.5%. |
| Jasti, et al. [125] |
Prospective Multicentric |
n = 577 12% |
CAP related: 20% | CAP non-related: 74% Coronary heart disease: OR: 2.7 (CI 95%: 1.5–4.7) COPD: OR: 2.3 (CI 95%: 1.3–4.1) |
Social factors: Basic education OR: 2 (CI 95%: 1.1–3.4). Unemployment OR: 3.7 (CI 95%: 1.1–12.3) |
| Chakrabarti, et al. [126] | Prospective Multicentric |
n = 12.157 (26%) |
No records | Non-metastatic cancer: OR: 1.7 (CI 95%: 1.3–1.7) Complicated diabetes: OR: 1.6 (CI 95%: 1.2–1.8) Chronic kidney disease: OR: 1.2 (CI 95%: 1.1–1.3) Dementia: OR: 0.8 (CI 95%: 0.6–0.9) |
Those readmitted within 14 days were more likely to have metastatic cancer (6.6% vs. 4.5%; p = 0.03) compared to those readmitted at 15–30 days. |
| Toledo, et al. [110] |
Prospective Multicentric |
n = 1756 over 65 (11.4%) |
CAP related: 44.5% | CAP non-related: 50%. Living with a person aged under 15—OR: 2.10 (95% CI 1.01 to 4.41) ≥3 hospital admissions in previous 90 days—OR: 1.53 (95% CI 1.01 to 2.34) Chronic respiratory failure—OR: 1.74 (95% CI 1.24 to 2.45) Heart failure—OR: 1.69 (95% CI 1.21 to 2.35) Chronic liver disease—OR: 2.27 (95% CI 1.20 to 4.31) discharge to hospital at home unit—OR: 5.61 (95% CI 1.70 to 18.50) |
No associations were found with seasonal influenza or pneumococcal vaccination in any of the three previous seasons. |
| Jang, et al. [127] |
Retrospective Multicentric |
n = 862 (8.4%) |
CAP related: 37.5% clinical instability at discharge (≥1)—HR: 5.3; (CI 95%: 2.2–13.2) PSI ≥ 4 —HR: 10; (CI 95%: 1.4–75.5) |
CAP non-related: 62.5%. Chronic kidney disease: OR: 5.7 (95% CI, 2.2–14.7) Chronic lung disease: OR: 2.8 (95% CI: 1.3–5.9) |
CAP related and non-related in 16% |
| Mather, et al. [128] |
Retrospective Multicentric |
n = 965 (15.5%) |
CAP related: 16.9% Hematocrit below 30% Leucocytosis over 12,000 mm3 |
Male sex (OR 1.59, 95% CI 1.03–2.45) 3 or more previous admissions (OR 1.84, 95% CI 1.22–2.78) COPD (OR 1.63, 95% CI 1.07 to 2.48) Cancer (OR 2.18, 95% CI 1.24 to 3.84) Median income under <$43,000 (OR 1.82, 95% CI 1.18 to 2.81) History of anxiety or depression (OR 1.62, 95% CI 1.04 to 2.52) Hematocrit under 30% (OR 1.86, 95% CI 1.07 to 3.22) |
This study analyses mainly non-related CAP |
| Nguyen, et al. [130] |
Retrospective Single centre |
n = 582 (11.9%) |
CAP related: 43.5% Multidrug-resistant bacteria OR: 2.6 (IC 95%: 1.1–6.6) |
Charlson Comorbidity Score ≥ 3 OR: 1.4 (CI 95%: 1.1–1.8) Most frequent comorbidities:Cardiovascular, Chronic kidney disease, |
The only study in which CAP related are the most frequent. |
| Halm, et al. [131] |
Prospective Single centre |
n = 680 (9.9%) |
clinical instability at discharge (=1) OR: 1.6; (IC95%, 1.0–2.8) clinical instability at discharge (≥2) OR: 5.4; (IC95%, 1.6–18.4) |
19.1% were discharged with 1 or more instabilities. 10.5% of patients with no instabilities were readmitted vs. 13.7% whohad 1 instability or 46.2% of those with ≥2 instabilities (p < 0.003) |