Incidence and Mortality of Adults Hospitalized with Community-Acquired Pneumonia According to Clinical Course

Paula Peyrani, Forest W Arnold, Jose Bordon, Stephen Furmanek, Carlos M Luna, Rodrigo Cavallazzi, Julio Ramirez
Chest 2019 October 11

BACKGROUND: After hospitalization for community-acquired pneumonia (CAP), patients' clinical course may progress to clinical improvement, clinical failure, or non-resolving pneumonia. The epidemiology and outcomes of patients with CAP according to clinical course has not been well-studied. The objective of this study was to characterize the incidence and outcomes for each clinical course of hospitalized patients with CAP.

METHODS: This was a secondary data analysis of the University of Louisville Pneumonia study. Clinical course was classified as improvement, failure, and non-resolving. Objective criteria were used to define improvement and failure during the first week of the hospitalization. If neither group of criteria were met, course was classified as non-resolving. Incidence for each clinical course was calculated. Mortality was evaluated at different timepoints through the first year. P-values <0.05 were considered statistically significant.

RESULTS: A total of 7,449 patients were hospitalized with CAP during the study period. Improvement was documented in 5,732 (77%) of the patients, failure in 1,458 (20%) of the patients, and non-resolving CAP in 259 (3%) of the patients. Mortality at 30-days was 6% for those who improved, 34% for those who failed and 34% for those with non-resolving pneumonia. Mortality at 1-year was 23%, 52% and 51%, respectively.

CONCLUSIONS: This study shows that over 75% of hospitalized patients with CAP will reach clinical improvement. One out of two patients with clinical failure or non-resolving CAP may die one year after hospitalization. Understanding the pathogenesis of long-term mortality is critical to developing interventions.


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