Socio-demographic and comorbid risk factors for poor prognosis in patients hospitalized with community-acquired bacterial pneumonia in southeastern US

• Published in: Heart & lung 2024-05, Vol.65, p.31-39
• Main Authors: Idigo, Adeniyi J., Wells, J. Michael, Brown, Matthew L., Wiener, Howard W., Griffin, Russell L., Cutter, Gary, Shrestha, Sadeep, Lee, Rachael A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Community-acquired bacterial pneumonia; Community-Acquired Infections - epidemiology; Community-Acquired Infections - therapy; Comorbidities; Diabetes Mellitus, Type 2; Heart Failure - epidemiology; Hospital Mortality; Hospitalization; Humans; Length of hospital stay; Length of Stay; Male; Mortality; Obesity; Pneumonia - epidemiology; Pneumonia - therapy; Pneumonia, Bacterial; Poor prognosis; Prognosis; Readmission; Retrospective Studies; Risk Factors; Stroke
• ISSN: 0147-9563; 1527-3288; 1527-3288
• DOI: 10.1016/j.hrtlng.2024.01.010

•Certain comorbidities and socio-demographic characteristics increase the risk of a patient's hospitalization for community-acquired pneumonia (CAP).•How a patient's factors affect bacterial CAP prognosis during and after hospitalization is important in disease management.•Heart failure, stroke, diabetes, obesity, and COPD were associated with poor disease prognosis as measured by medical intensive care unit admission, higher length of hospital stay, in-hospital mortality, or readmission within one year with recurrent bacterial CAP.•Socio-demographic characteristics including age, sex, race, and admission source, were also associated with poor disease prognosis. How socio-demographic characteristics and comorbidities affect bacterial community-acquired pneumonia (CAP) prognosis during/after hospitalization is important in disease management. To identify predictors of medical intensive care unit (MICU) admission, length of hospital stay (LOS), in-hospital mortality, and bacterial CAP readmission in patients hospitalized with bacterial CAP. ICD-9/10 codes were used to query electronic medical records to identify a cohort of patients hospitalized for bacterial CAP at a tertiary hospital in Southeastern US between 01/01/2013–12/31/2019. Adjusted accelerated failure time and modified Poisson regression models were used to examine predictors of MICU admission, LOS, in-hospital mortality, and 1-year readmission. There were 1956 adults hospitalized with bacterial CAP. Median (interquartile range) LOS was 11 days (6–23), and there were 26 % (513) MICU admission, 14 % (266) in-hospital mortality, and 6 % (117) 1-year readmission with recurrent CAP. MICU admission was associated with heart failure (RR 1.38; 95 % CI 1.17–1.62) and obesity (RR 1.26; 95 % CI 1.04–1.52). Longer LOS was associated with heart failure (adjusted time ratio[TR] 1.27;95 %CI 1.12–1.43), stroke (TR 1.90;95 %CI 1.54,2.35), type 2 diabetes (TR 1.20;95 %CI 1.07–1.36), obesity (TR 1.50;95 %CI 1.31–1.72), Black race (TR 1.17;95 %CI 1.04–1.31), and males (TR 1.24;95 %CI 1.10–1.39). In-hospital mortality was associated with stroke (RR 1.45;95 %CI 1.03–2.04) and age ≥65 years (RR 1.34;95 %CI 1.06–1.68). 1-year readmission was associated with COPD (RR 1.55;95 %CI 1.05–2.27) and underweight BMI (RR 1.74;95 %CI 1.04–2.90). Comorbidities and socio-demographic characteristics have varying impacts on bacterial CAP in-hospital prognosis and readmission. More studies are warranted to confirm these findings to d