Predictors and Implications of Early Clinical Stability in Patients Hospitalized for Moderately Severe Community-Acquired Pneumonia.

Détails

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_D0B195B53E94
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Predictors and Implications of Early Clinical Stability in Patients Hospitalized for Moderately Severe Community-Acquired Pneumonia.
Périodique
PloS one
Auteur(s)
Garin N., Felix G., Chuard C., Genné D., Carballo S., Hugli O., Lamy O., Marti C., Nendaz M., Rutschmann O., Harbarth S., Perrier A.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Statut éditorial
Publié
Date de publication
2016
Peer-reviewed
Oui
Volume
11
Numéro
6
Pages
e0157350
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: epublish
Résumé
Assessment of early response to treatment is crucial for the management of community-acquired pneumonia (CAP).
To describe the predictors and the outcomes of early clinical stability.
We did a secondary analysis of a multicentre randomized controlled trial on CAP treatment in which 580 patients hospitalized for moderately severe CAP were included. The association between demographic, clinical and biological variables available at inclusion and early clinical stability (stabilization of vital signs within 72 hours with predetermined cut-offs) was assessed by multivariate logistic regression. The association between early clinical stability and mortality, severe adverse events, and length of stay was also tested.
Younger age (OR 0.98, 95% CI 0.96-0.99), lower platelet count (OR per 10 G/L increment 0.96, 95% CI 0.94-0.98), lower respiratory rate (OR 0.94, 95% CI 0.90-0.97), absence of hypoxemia (OR 0.58, 95% CI 0.40-0.85), lower numbers of co-morbid conditions (OR 0.82, 95% CI 0.69-0.98) and signs or symptoms (OR 0.78, 95% CI 0.68-0.90) were significantly associated with early clinical stability. Patients with early clinical stability had lower 90-days mortality (3.4% vs. 11.9%, p<0.001), fewer admissions to the intensive care unit (2.7% vs. 8.0%, p = 0.005) and a shorter length of stay (6.0 days, IQR 4.0-10.0 vs. 10.0 days, IQR 7.0-15.0, p<0.001).
Patients with younger age, less co-morbidity, fewer signs or symptoms, less respiratory compromise, and a lower platelet count are more likely to reach early clinical stability. Patients without early clinical stability have a worse prognosis and warrant close scrutiny.

Mots-clé
Adult, Age Factors, Aged, Community-Acquired Infections/drug therapy, Community-Acquired Infections/pathology, Female, Hospitalization/statistics & numerical data, Humans, Length of Stay/statistics & numerical data, Male, Middle Aged, Multicenter Studies as Topic, Multivariate Analysis, Outcome Assessment (Health Care)/methods, Outcome Assessment (Health Care)/statistics & numerical data, Pneumonia/drug therapy, Pneumonia/pathology, Prognosis, Randomized Controlled Trials as Topic, Severity of Illness Index, Time Factors, Young Adult
Pubmed
Web of science
Open Access
Oui
Création de la notice
17/06/2016 17:49
Dernière modification de la notice
20/08/2019 15:50
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