Length of stay (LOS) in hospital for community-acquired pneumonia depends on the characteristics of the patient and hospital. The present study sought to identify these variables within the first 24 h of hospitalisation.Patients hospitalised for pneumonia in four hospitals (one teaching and three general hospitals) had their data analysed by univariate and multivariate statististics. The variables entered were LOS, demographical characteristics, referral source, comorbidity, initial severity of illness, laboratory analyses, initial radiograph findings and antibiotic treatment regimens.The study sample included 425 patients. The overall mortality was 8.2% and the median LOS was 9 days. Using LOS as a dependent variable, three multivariate linear regression analyses were performed with: 1) the whole cohort; 2) the low-risk classes (categories I and II of Fine); and 3) the high-risk classes (categories III, IV and V of Fine). The mathematical model identified hypoxemia, low diastolic pressure, pleural effusion, multi-lobe involvement and hypoalbuminaemia as associated with longer stays in risk classes III-V, while in the low-risk patients (I-II) only hypoxemia and pleural effusion appeared in the equation. Following adjustment for these clinical variables, the LOS remained lower in some hospitals.Several independent clinical factors increased the pneumonia-associated length of stay with significant differences between hospitals. Hypoxemia and pleural effusions were the predictive variables of length of stay in low-risk patients and, additionally, diastolic blood pressure, multi-lobe involvement and hypoalbuminaemia were significant in the higher-risk classes III-V. Eur Respir J 2003; 22: 643-648. Community-acquired pneumonia (CAP) is the cause of hospitalisation for 3-5 per 1000 adults per year and with a mortality rate of 5-15%. Pneumonia is the infectious disease with the highest health costs [1][2][3][4] and, since approximately one-third of all patients with CAP are treated in hospital, the resulting costs constitute a significant part of the overall direct costs of infectious diseases [5][6][7]. The most important component of these costs is the length of stay (LOS) in hospital and estimates indicate these costs to be higher than those of the diagnostic tests involved and the subsequent antimicrobial treatments administered [6].There is considerable variability in LOS between hospitals. Reported findings are discordant and depend on the types of hospital in which the different studies had been conducted [8][9][10][11]. The differences might reflect variations in clinical practice preferences, hospital characteristics and patient characteristics and attitudes. Over recent years the LOS appears to have decreased from 9 to 6 days [12, 13] as a result of several strategies and practical guidelines that have been proposed in order to safely reduce the number of hospitalisation days [14].The LOS is influenced by several clinical factors, such as the Pneumonia Severity Index (PSI) [15] associated comorbidit...

Here we report a rapid and simple method to analyze an AccH polymorphism within the human p53 gene using the polymerase chain reaction. PCR Primers: The primer sequences corresponded to the 4th exon of the human p53 gene as described by Lamb (1). Sense oligo 5'-AATGGATGATTTGATGCTGTCCC-3' Antisense oligo 5'-CGTGCAAGTCACAGACTTGGC-3' Polymorphism: AccH (CGCG) digest of the amplified fragment identifies two alleles; Al = 259 bp and A2 = 160 bp + 99 bp. Frequency: Allele frequencies were calculated from 90 unrelated Caucasians. Al = 0.32 A2 = 0.68 Chromosomal Localization: The polymorphic AccH recognition site occurs within the 4th exon of the human p53 locus (17ql3) (2). Mendelian Inheritance: Co-dominant segregation demonstrated in 6 two-generation families. PCR Conditions: PCRs were carried out in a total volume of 50 ,ul containing: 500 ng of genomic DNA, 50 pmoles of each prii.ler, 2 mM MgCl2, 200 AM dNTPs, 50 mM KCl, 20 mM Tris-pH 8.3 and 0.1 % gelatine. The amplification is performed for 35 cycles with an annealing temperature of 62°C. The amplified DNA is digested overnight with a tenfold excess of AccH. DNA fragments are resolved by electrophoresis through a 2% agarose gel or a 7% polyacrylamide gel. Acknowledgements: This work was supported by a CAICYT Grant # PB 86-0046 del Ministerio de Educaci6n y Ciencia. 0. de la Calle-Martin was supported by a Hospital Clinic grant.

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We report two patients with leukaemic proliferations of large granular lymphocytes. The immunophenotype study showed that the leukaemic cells were positive for CD2, CD38, CD56 and anti-HLA-DR monoclonal antibodies and negative for other T-cell (CD3, CD4, CD8) and B-cell markers (CD19, CD20 and surface immunoglobulins). The clinical course was acute and a diagnosis of aggressive natural killer cell leukaemia/lymphoma was made. No clonal rearrangements of either C beta T-cell receptor or JH immunoglobulin genes were found. Functional studies done in one patient demonstrated non-restricted cytotoxic activity after activation with IL-2. Lethal midline granuloma had been previously diagnosed in both patients. A possible relationship between this entity and the natural killer cell leukaemia is discussed.