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

Abstract

BackgroundHow socio-demographic characteristics and comorbidities affect bacterial community-acquired pneumonia (CAP) prognosis during/after hospitalization is important in disease management. ObjectivesTo 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. MethodsICD-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. ResultsThere 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). ConclusionsComorbidities and socio-demographic characteristics have varying impacts on bacterial CAP in-hospital prognosis and readmission. More studies are warranted to confirm these findings to develop comprehensive care plans and inform public health interventions.