Physiological and biological predictors of length of stay and recovery in adults with acute asthma: an observational cohort study

Thomas L. Jones, Jonathon Owen, Scott Elliott, Thomas Brown, Dominic Reynish, Heena Mistry, Sumita Kerley, Salah Matti, Janis K. Shute, Anoop J. Chauhan

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Abstract

Introduction - Asthma is a prevalent, chronic disease associated with significant risk to patients and cost to healthcare systems. Accurate estimates of length of stay and recovery are important for patient information, physician prognostication, and management of inpatient beds.

Objectives - To assess factors affecting length of stay and time to recovery in adults with acute asthma.

Methods - We prospectively recruited adult asthmatic non-smokers admitted with an asthma exacerbation. Participants were assessed for demographics, symptoms, medications, bloods including blood count, clotting status, and cytokines. Results were analyzed for correlation and subsequently in a regression model.

Results - 126 participants were recruited of which 75.4% were female. Mean age was 40.0 and mean length of stay 3.98 days. Length of stay was associated with lower APTT ratio (<p=0.001), oxygen requirement (p=0.02), increased AST (p=0.005), increasing age (p=0.02) and lower %predicted FEV1 (p=0.02). Delayed recovery was associated with plasma IL-12 >1pg/mL (p=0.04).

Conclusion - Older participants with lower FEV1 and supplemental oxygen requirements are likely to remain in hospital longer. Activation of the “intrinsic” clotting pathway correlates with an increased length of stay as does a raised serum AST. Detectable IL-12 in plasma correlates with slower recovery and this may be due to poor response to corticosteroids.
Original languageEnglish
Pages (from-to)200-206
JournalThe Clinical Respiratory Journal
Volume12
Issue number1
Early online date14 Jul 2016
DOIs
Publication statusPublished - 1 Jan 2018

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