Risk factors for 3-month mortality in bedridden patients with hospital-acquired pneumonia: A multicentre prospective study.

Jing Jiao,Xinjuan Wu,Xianxiu Wen,Baoyun Song,Yilan Liu,Xia Wan,Jing Cao,Jingfen Jin,Zhen Li,Fangfang Li,Chen Zhu,Ying Liu,Ge Liu,Shouzhen Cheng

doi:10.1371/journal.pone.0249198

Abstract

Mortality among patients with hospital-acquired pneumonia (HAP) is quite high; however, information on risk factors for short-term mortality in this population remains limited. The aim of the current study was to identify the risk factors for mortality in bedridden patients with HAP during a 3-month observation period. A secondary data analysis was conducted. In total, 1141 HAP cases from 25 hospitals were included in the analysis. Univariate and multilevel regression analyses were performed to identify the risk factors for mortality. During the 3-month observation period, there were 189 deaths among bedridden patients with HAP. The mortality rate in this study was 16.56%. Multilevel regression analysis showed that ventilator-associated pneumonia (OR = 2.034, 95%CI: 1.256, 3.296, p = 0.004), pressure injuries (OR = 2.202, 95%CI: 1.258, 3.852, p = 0.006), number of comorbidities (OR = 1.076, 95%CI: 1.016,1.140, p = 0.013) and adjusted Charlson Comorbidity Index score (OR = 1.210, 95%CI: 1.090, 1.343, p<0.001) were associated with an increased risk of mortality, while undergoing surgery with general anaesthesia (OR = 0.582, 95%CI: 0.368, 0.920, p = 0.021) was associated with a decreased risk of mortality. The identification of risk factors associated with mortality is an important step towards individualizing care plans. Our findings may help healthcare workers select high-risk patients for specific interventions. Further study is needed to explore whether appropriate interventions against modifiable risk factors, such as reduced immobility complications or ventilator-associated pneumonia, could improve the prognoses.

Highlights

Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a pulmonary infection that develops in patients hospitalized for more than 48 hours in the intensive care unit (ICU) or in other wards [1].Ventilator-associated pneumonia (VAP) is a subcategory of hospital-acquired pneumonia (HAP) that occurs in mechanically ventilated patients more than 48 hours after tracheal intubation [2]
Multilevel regression analysis showed that ventilator-associated pneumonia (OR = 2.034, 95%CI: 1.256, 3.296, p = 0.004), pressure injuries (OR = 2.202, 95%CI: 1.258, 3.852, p = 0.006), number of comorbidities (OR = 1.076, 95%CI: 1.016,1.140, p = 0.013) and adjusted Charlson Comorbidity Index score (OR = 1.210, 95%CI: 1.090, 1.343, p
Further study is needed to explore whether appropriate interventions against modifiable risk factors, such as reduced immobility complications or ventilatorassociated pneumonia, could improve the prognoses

Summary

Introduction

Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, is a pulmonary infection that develops in patients hospitalized for more than 48 hours in the intensive care unit (ICU) or in other wards [1]. Ventilator-associated pneumonia (VAP) is a subcategory of HAP that occurs in mechanically ventilated patients more than 48 hours after tracheal intubation [2]. In the United States, HAP is the second most common nosocomial infection, with an incidence ranging from 5 to more than 20 cases per 1000 hospital admissions [4]. Mortality among patients with hospital-acquired pneumonia (HAP) is quite high; information on risk factors for short-term mortality in this population remains limited. The aim of the current study was to identify the risk factors for mortality in bedridden patients with HAP during a 3-month observation period

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Conclusion