Factors associated with pneumonia severity and the role of fatigue in 30-day readmission among hospitalized adults with community-acquired pneumonia.

BACKGROUND

Community-acquired pneumonia (CAP) is a common infectious disease with a substantial risk of short-term readmission after discharge.

OBJECTIVES

This study examined factors associated with pneumonia severity in hospitalized patients with CAP and explored whether fatigue severity and fatigue interference were statistically consistent with mediation of the association between pneumonia severity and 30-day readmission.

METHODS

This longitudinal correlational study recruited 122 hospitalized patients with CAP from a regional teaching hospital in northern Taiwan. Demographic and clinical characteristics, pneumonia severity, fatigue severity, fatigue interference, and 30-day readmission were collected. Data were analyzed using correlation tests, regression models, bootstrapped mediation analysis, and sensitivity analysis with a modified CURB score excluding age.

RESULTS

In the primary CURB-65 analysis, pneumonia severity was associated with age, COVID-19 infection history, and Charlson Comorbidity Index score. Sensitivity analysis using a modified CURB score excluding age revealed that age was no longer significant. In addition, fatigue interference remained associated with 30-day readmission in the exploratory multivariable model (OR = 1.45, 95% CI = 1.05 to 1.99, p = .022), and bootstrapped mediation analysis showed significant indirect associations through fatigue severity and fatigue interference.

CONCLUSION

Fatigue may partly explain the association between pneumonia severity and 30-day readmission in hospitalized patients with CAP. Fatigue assessment may provide useful information for discharge planning and transitional care. Given the observational design, limited readmission events, and potential unmeasured confounding, these findings should be interpreted as preliminary associations statistically consistent with mediation rather than evidence of causality.