Delay and factors associated with early clinical stability during community-acquired pneumonia: A case control study

To evaluate the proportion of hospitalized patients with community-acquired pneumonia (CAP) achieving early clinical stability and to identify factors associated with failure to reach stability by Day 3, as well as its impact on clinical outcomes.

We conducted a case-control study including 231 hospitalized patients with CAP. Early clinical stability at Day 3 was assessed using predefined clinical criteria. Multivariable logistic regression analysis was performed to identify factors independently associated with failure to achieve early stability.

Overall, 61% of patients achieved clinical stability by Day 3. Residence in a long-term care facility (adjusted OR 4.1, 95% CI 1.6-11.4) and active neoplasia (adjusted OR 5.5, 95% CI 1.5-25.9) were independently associated with failure to reach early stability. Persistent oxygen requirement was the most frequent criterion for instability. Patients achieving early stability had significantly lower mortality (2.1% vs 17.8%) and fewer ICU admissions (0% vs 12.2%) compared with unstable patients.

Early clinical stability is a strong prognostic marker in hospitalized patients with CAP and is associated with improved outcomes. These findings support the use of stability assessment to guide individualized antibiotic duration and management strategies based on patient characteristics.