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Inicio Enfermedades Infecciosas y Microbiología Clínica Ingresos, estancia y mortalidad de las neumonías adquiridas en la comunidad en ...
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Vol. 22. Issue 2.
Pages 64-69 (February 2004)
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Vol. 22. Issue 2.
Pages 64-69 (February 2004)
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Ingresos, estancia y mortalidad de las neumonías adquiridas en la comunidad en un hospital de agudos. Correlación entre el índice pronóstico de severidad y los criterios clínicos tradicionales de valoración de la gravedad
Hospital admission, duration of stay and mortality in community-acquired pneumonia in an acute care hospital. Correlation between a pneumonia prognosis index and conventional clinical criteria for assessing severity
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Esther Calbo1
Corresponding author
32700ecs@comb.es

Correspondencia: Dra. E. Calbo. Servicio de Medicina Interna. Hospital Mútua de Terrassa. Pl. Dr. Robert. 08221 Terrassa. Barcelona. España.
, Anna Ochoa de Echagüen, Mónica Rodríguez-Carballeira, Carles Ferrer, Javier Garau
Servicio de Medicina Interna. Hospital Mútua de Terrassa. Terrassa. Barcelona. España
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Introducción

Nuestro objetivo fue evaluar el tratamiento de la neumonía adquirida en la comunidad (NAC) según los criterios convencionales comúnmente aplicados, comparándolos con el índice pronóstico de severidad (IPS) y analizar los factores relacionados con la necesidad de ingreso en la categoría III del IPS

Métodos

Se incluyeron prospectivamente los pacientes adultos con NAC atendidos durante 1999. A su llegada se recopilaron los datos necesarios para el cálculo del IPS; al alta, los días de estancia, la ubicación y la mortalidad

Resultados

Se recogieron 447 casos de NAC. El 55,7% pertenecía a las categorías IV o V. Se produjeron 27 muertos (6,1%), el 97% en categorías IV y V. Hubo 362 ingresos, 302 (83%) pertenecían a las categorías III, IV y V. Se trataron de forma ambulatoria 85 pacientes (el 60% eran de categoría I o II). Se ha observado un aumento en la tasa de reingresos de forma proporcional a la categoría de riesgo que oscila del 4% en la categoría I al 18% en la categoría IV. En la categoría III (con 80 enfermos) se produjeron 63 ingresos (79%), con una estancia media de 7,89 días. En esta categoría, la presencia de alteraciones en la exploración física o analítica fue un factor asociado al ingreso (OR, 7,62 [1,5-35,2])

Conclusión

El IPS se ha mostrado útil en nuestra cohorte en la estratificación de enfermos por gravedad y como factor asociado a la necesidad de ingreso y de reingreso. En categoría III, la variable mejor relacionada con la hospitalización fue la gravedad de la NAC y no la presencia de comorbilidad

Palabras clave:
Neumonía
Gravedad
Hospitalización
Introduction

The objective of this study was to evaluate the management of community acquired pneumonia (CAP) according to conventional clinical criteria applied in the emergency room as compared to a pneumonia prognosis index (PPI) (Fine et al. NEJM 1997). We also analyzed which factors were associated with the need for inpatient treatment in PPI risk category III patients

Methods

We prospectively enrolled all adults with CAP seen in the emergency room during 1999. The data required to calculate the PPI were collected at admission. Mortality and length of stay were recorded at discharge

Results

A total of 447 patients with CAP were collected, 55.7% in the high-risk classes IV and V. Twenty-seven patients died (6.1%) and 97% of these were within the high-risk classes. There were 362 hospitalizations; 302 (83%) were classes III, IV and V. The readmission rate increased with increases in the risk class, with a range of 4% for class I to 18% for class IV. Eighty-five patients (19%) were treated on an outpatient basis

Risk class III included 80 patients; 63 (79%) were hospitalized, with a length of stay of 7.89 days. The factor most highly associated with hospitalization in this group was abnormal findings on physical examination or on laboratory testing and radiographic studies. (OR: 7.62 [1.5-35.2])

Conclusions

In our cohort, the PPI was effective for identifying low-risk patients with CAP who could be treated as outpatients. In risk class III patients, the severity of the disease was the strongest predictor of hospitalization, rather than the presence of comorbid conditions

Key words:
Pneumonia
Severity
Hospitalization
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Copyright © 2004. Elsevier España, S.L.. Todos los derechos reservados
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