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Development of a prognostic index for 90-day mortality among patients discharged after hospitalization for community-acquired pneumonia
  1. Alberto Capelastegui, MD, PhD (alberto.capelasteguisaiz{at}osakidetza.net)
  1. Hospital De Galdakao, Spain
    1. Pedro Pablo España MD (pedropablo.espanayandiola{at}osakidetza.net)
    1. Hospital De Galdakao, Spain
      1. Jose Maria Quintana, MD, PhD (josemaria.quintanalopez{at}osakidetza.net)
      1. Hospital De Galdakao, Spain
        1. Amaia Bilbao, MSc (abilbao{at}bioef.org)
        1. Basque Foundation for Health Innovation and Research (BIOEF), Spain
          1. Rosario Menendez, MD, PhD (rmenend{at}separ.es)
          1. Hospital La Fe, Spain
            1. Rafael Zalacain, MD, PhD (rafael.zalacainjorge{at}osakidetza.net)
            1. Hospital Cruces, Spain
              1. Antoni Torres, MD, PhD (atorres{at}ub.edu)
              1. Hospital Clinic, Spain

                Abstract

                Background: Patients hospitalized for community-acquired pneumonia (CAP) experience substantial short-term mortality following hospital discharge. However, few studies have focused on identifying factors that predict post-hospitalization mortality in this population. Our objective was to develop and validate a prognostic index for 90-day mortality after hospital discharge among patients with CAP.

                Methods: The prognostic index was derived in 1117 adult patients discharged between 2003 and 2007 from a general hospital following hospitalization for CAP. It was validated among 646 consecutive patients discharged from three other hospitals between November 1, 2005, and July 31, 2006. Risk factors evaluated included host related factors, severity upon admission, in-hospital management, and bacteriology.

                Results: In the derivation cohort, 3 factors were independently associated with 90-day mortality: pre-illness functional status (6 or 3 points), Charlson index (2 points), and the severity upon admission (2 points). 90-day mortality was 0.7% in the low-risk group (0-2 points), 3.5% in the intermediate-risk group (3-7 points), and 17.3% in the high-risk group (>7 points). In the validation cohort, mortality was 0.6%, 3.9%, and 20.8% respectively. Compared with the low-risk group, the odds ratio was 47.3 for the high-risk group. The risk categories showed an area under the receiver operating characteristic curve of 0.79 in the derivation cohort and 0.83 in the validation cohort.

                Conclusions: The prognostic index accurately stratifies patients hospitalized for CAP into low-, intermediate-, and high-risk groups for 90-day mortality upon discharge. The use of this index could help clinicians improve outcomes in this vulnerable population by targeting specific interventions to each group.

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