tetano
Editor, Senior Moderator
Lancet Reg Health Southeast Asia
. 2024 Feb 29:25:100363.
doi: 10.1016/j.lansea.2024.100363. eCollection 2024 Jun. Post-discharge mortality among patients hospitalised with severe acute respiratory infection, Bangladesh, 2012-2019: a prospective observational study
Md Ariful Islam[SUP] 1 [/SUP], Md Zakiul Hassan[SUP] 1 [/SUP], Mohammad Abdul Aleem[SUP] 1 [/SUP], Zubair Akhtar[SUP] 1 [/SUP], Sukanta Chowdhury[SUP] 1 [/SUP], Md Kaousar Ahmmed[SUP] 1 [/SUP], Mustafizur Rahman[SUP] 1 [/SUP], Mohammed Ziaur Rahman[SUP] 1 [/SUP], Syeda Mah-E-Muneer[SUP] 1 [/SUP], M Salim Uzzaman[SUP] 1 [/SUP], Tahmina Shirin[SUP] 2 [/SUP], Meerjady Sabrina Flora[SUP] 3 [/SUP], Mahmudur Rahman[SUP] 4 [/SUP], William W Davis[SUP] 5 [/SUP], Eduardo Azziz-Baumgartner[SUP] 5 [/SUP], A Danielle Iuliano[SUP] 5 [/SUP], Fahmida Chowdhury[SUP] 1 [/SUP]
Affiliations
Background: Enhancing outcomes post-hospitalisation requires an understanding of predictive factors for adverse events. This study aimed to estimate post-discharge mortality rates among patients with severe acute respiratory infection (SARI) in Bangladesh, identify associated factors, and document reported causes of death.
Methods: From January 2012 to December 2019, we conducted follow-up calls to patients or their families 30 days after discharge to assess the status of patients with SARI. Proportions of deaths within 30 days of discharge were estimated, and a comparative analysis of demographics, clinical characteristics, and influenza illness between decedents and survivors was performed using multivariable Cox regression models.
Findings: Among 23,360 patients with SARI (median age: 20 years, IQR: 1.5-48, 65% male), 351 (1.5%) died during hospitalisation. Of 23,009 patients alive at discharge, 20,044 (87%) were followed, with 633 (3.2%) deaths within 30 days of discharge. In children (<18 years), difficulty breathing (adjusted hazard ratio [aHR] 1.8; 95% CI 1.1-3.0), longer hospital stay (aHR 1.1; 95% CI 1.1-1.1), and heart diseases (aHR 8.5; 95% CI 3.2-23.1) were associated with higher post-discharge death risk. Among adults (≥18 years), difficulty breathing (aHR 2.3; 95% CI 1.7-3.0), chronic obstructive pulmonary disease (aHR 1.7; 95% CI 1.4-2.2), and intensive care unit admission (aHR 5.2; 95% CI 1.9-14.0) were linked to elevated post-discharge death risk. Influenza virus was detected in 13% (46/351) of in-hospital SARI deaths and 10% (65/633) of post-discharge SARI deaths.
Interpretation: Nearly one in twenty patients with SARI died during hospitalisation or within 1 month of discharge, with two-thirds of deaths occurring post-discharge. Seasonal influenza vaccination is recommended to mitigate influenza-associated mortality. To enhance post-discharge outcomes, hospitals should consider developing safe-discharge algorithms, reinforcing post-discharge care plans, and establishing outpatient monitoring for recently discharged patients.
Funding: Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA [U01GH002259].
Keywords: Bangladesh; Influenza; Post-discharge mortality; Severe acute respiratory infection; Surveillance.
. 2024 Feb 29:25:100363.
doi: 10.1016/j.lansea.2024.100363. eCollection 2024 Jun. Post-discharge mortality among patients hospitalised with severe acute respiratory infection, Bangladesh, 2012-2019: a prospective observational study
Md Ariful Islam[SUP] 1 [/SUP], Md Zakiul Hassan[SUP] 1 [/SUP], Mohammad Abdul Aleem[SUP] 1 [/SUP], Zubair Akhtar[SUP] 1 [/SUP], Sukanta Chowdhury[SUP] 1 [/SUP], Md Kaousar Ahmmed[SUP] 1 [/SUP], Mustafizur Rahman[SUP] 1 [/SUP], Mohammed Ziaur Rahman[SUP] 1 [/SUP], Syeda Mah-E-Muneer[SUP] 1 [/SUP], M Salim Uzzaman[SUP] 1 [/SUP], Tahmina Shirin[SUP] 2 [/SUP], Meerjady Sabrina Flora[SUP] 3 [/SUP], Mahmudur Rahman[SUP] 4 [/SUP], William W Davis[SUP] 5 [/SUP], Eduardo Azziz-Baumgartner[SUP] 5 [/SUP], A Danielle Iuliano[SUP] 5 [/SUP], Fahmida Chowdhury[SUP] 1 [/SUP]
Affiliations
- PMID: 39021479
- PMCID: PMC467067
- DOI: 10.1016/j.lansea.2024.100363
Background: Enhancing outcomes post-hospitalisation requires an understanding of predictive factors for adverse events. This study aimed to estimate post-discharge mortality rates among patients with severe acute respiratory infection (SARI) in Bangladesh, identify associated factors, and document reported causes of death.
Methods: From January 2012 to December 2019, we conducted follow-up calls to patients or their families 30 days after discharge to assess the status of patients with SARI. Proportions of deaths within 30 days of discharge were estimated, and a comparative analysis of demographics, clinical characteristics, and influenza illness between decedents and survivors was performed using multivariable Cox regression models.
Findings: Among 23,360 patients with SARI (median age: 20 years, IQR: 1.5-48, 65% male), 351 (1.5%) died during hospitalisation. Of 23,009 patients alive at discharge, 20,044 (87%) were followed, with 633 (3.2%) deaths within 30 days of discharge. In children (<18 years), difficulty breathing (adjusted hazard ratio [aHR] 1.8; 95% CI 1.1-3.0), longer hospital stay (aHR 1.1; 95% CI 1.1-1.1), and heart diseases (aHR 8.5; 95% CI 3.2-23.1) were associated with higher post-discharge death risk. Among adults (≥18 years), difficulty breathing (aHR 2.3; 95% CI 1.7-3.0), chronic obstructive pulmonary disease (aHR 1.7; 95% CI 1.4-2.2), and intensive care unit admission (aHR 5.2; 95% CI 1.9-14.0) were linked to elevated post-discharge death risk. Influenza virus was detected in 13% (46/351) of in-hospital SARI deaths and 10% (65/633) of post-discharge SARI deaths.
Interpretation: Nearly one in twenty patients with SARI died during hospitalisation or within 1 month of discharge, with two-thirds of deaths occurring post-discharge. Seasonal influenza vaccination is recommended to mitigate influenza-associated mortality. To enhance post-discharge outcomes, hospitals should consider developing safe-discharge algorithms, reinforcing post-discharge care plans, and establishing outpatient monitoring for recently discharged patients.
Funding: Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA [U01GH002259].
Keywords: Bangladesh; Influenza; Post-discharge mortality; Severe acute respiratory infection; Surveillance.