Session: Poster Session: The World of Community-Acquired Pneumonia
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: Little is known about the long-term sequelae of community-acquired pneumonia (CAP). Therefore, we describe the long-term morbidity and mortality of patients after pneumonia requiring hospitalization. Methods: Between 2000 and 2002, 3415 adults with CAP admitted to 6 hospitals in Edmonton, Alberta, Canada were prospectively enrolled in a population-based cohort. Post-discharge outcomes through to 2006 were ascertained using multiple linked administrative databases. Outcomes included all-cause mortality and re-hospitalization over a maximum of 5.4 years of follow-up. Results: Follow-up data was available for 3,284 (96%) patients; 66% were ≥65 years of age, 53% were male, and 63% had severe (PSI Class IV-V) pneumonia. Median follow-up was 3.8 years. The 30-day, 1-year and end of study mortality rates were 12%, 28%, and 53%, respectively. Overall, 82 (19%) patients <45 years of age died compared with 1456 (67%) patients ≥65 years [HR 5.07, 95% CI 4.06-6.34]. Males were more likely to die than females over follow-up [971 (56%) vs 767 (49%); HR 1.20, 95% CI 1.13-1.37]. Initial pneumonia severity predicted long-term post-discharge mortality with 92 (15%) of PSI class I-II patients dying vs 616 (82%) PSI class V patients [HR 11.80, 95% CI 4.70-14.70]. Of 2,950 patients who survived their initial CAP hospitalization, 72% were hospitalized again (median 2 admissions over follow-up) and 16% were re-hospitalized with pneumonia. Conclusions: Long-term morbidity and mortality is high following hospitalization for pneumonia. This suggests that patients with pneumonia, especially those with severe disease, may need closer follow-up due to their elevated risk of downstream adverse events and increased health resource utilization.