Do-not-resuscitate orders in patients with community-acquired pneumonia: a retrospective study.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_CCD973C3740D
Type
Article: article from journal or magazin.
Collection
Publications
Title
Do-not-resuscitate orders in patients with community-acquired pneumonia: a retrospective study.
Journal
BMC pulmonary medicine
Author(s)
Egelund G.B., Jensen A.V., Petersen P.T., Andersen S.B., Lindhardt B.Ø., Rohde G., Ravn P., von Plessen C.
ISSN
1471-2466 (Electronic)
ISSN-L
1471-2466
Publication state
Published
Issued date
24/07/2020
Peer-reviewed
Oui
Volume
20
Number
1
Pages
201
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
To investigate the use of do-not-resuscitate (DNR) orders in patients hospitalized with community-acquired pneumonia (CAP) and the association with mortality.
We assembled a cohort of 1317 adults hospitalized with radiographically confirmed CAP in three Danish hospitals. Patients were grouped into no DNR order, early DNR order (≤48 h after admission), and late DNR order (> 48 h after admission). We tested for associations between a DNR order and mortality using a cox proportional hazard model adjusted for patient and disease related factors.
Among 1317 patients 177 (13%) patients received a DNR order: 107 (8%) early and 70 (5%) late, during admission. Patients with a DNR order were older (82 years vs. 70 years, p < 0.001), more frequently nursing home residents (41% vs. 6%, p < 0.001) and had more comorbidities (one or more comorbidities: 73% vs. 59%, p < 0.001). The 30-day mortality was 62% and 4% in patients with and without a DNR order, respectively. DNR orders were associated with increased risk of 30-day mortality after adjustment for age, nursing home residency and comorbidities. The association was modified by the CURB-65 score Hazard ratio (HR) 39.3 (95% CI 13.9-110.6), HR 24.0 (95% CI 11.9-48,3) and HR 9.4 (95% CI: 4.7-18.6) for CURB-65 score 0-1, 2 and 3-5, respectively.
In this representative Danish cohort, 13% of patients hospitalized with CAP received a DNR order. DNR orders were associated with higher mortality after adjustment for clinical risk factors. Thus, we encourage researcher to take DNR orders into account as potential confounder when reporting CAP associated mortality.
Keywords
Community-acquired pneumonia, Do not resuscitate orders, Mortality
Pubmed
Open Access
Yes
Create date
11/08/2020 11:35
Last modification date
22/01/2024 8:48
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