Community acquired pneumonia (CAP) is a common and potentially serious illness with mortality rates cited as up to 13% in hospitalized patients. CURB-65 and Pneumonia Severity Index are two current tools predictive of mortality in CAP patients. Once admitted, it is important to identify patients at highest risk of mortality to better determine management. The purpose of our study was to investigate in a large multicenter cohort over a several year period, the association of specific risk factors with inpatient mortality in CAP patients.
This is a retrospective multicenter analysis of patients with CAP over an 11-year period from 4 large health care institutions. Participating centers included Henry Ford Health System, University of Maryland Medical System, Baylor Health Care System and Barnes Jewish Hospital. Patients were identified by diagnostic codes. Specifically, CAP patients were identified as those who received ceftriaxone, azithromycin, or respiratory fluoroquinolones within 24 hours of hospitalization. A computer stores generated database was used to obtain demographic data including age, sex, cultured organism, Charlson comorbidity index, length of stay (LOS) and therapy.
There were 24,393 patients classified as CAP. 1352 (5.4%) of these patients expired during the hospitalization. Those who expired were found to have significantly longer hospital LOS (14 vs 8 days, p <0.001), higher Charlson co-morbidity index (4.7 vs 3.6, p<0.001), and older age (over 66 yrs p<0.001). Organisms associated with higher mortality include MRSA and all gram negatives (p<0.001). S. pneumoniae did not show a significant difference. Pneumonia without sputum obtained and organism identification had lower mortality (p<0.001).
The results of our multicenter study suggest that CAP patients with more comorbid conditions have increased risk of mortality. Mortality was lower in this group than in past studies. Organism identification was helpful in patient management and identifying those at higher risk. However, patients without organisms identified had lower mortality suggesting appropriate coverage by current CAP regimens. Identifying high-risk patients early on should prompt more aggressive sepsis management and culture screening for proper antibiotic coverage to potentially improve mortality.
R. Sengupta, pfizer: Investigator , Research support
D. Moreno, pfizer: Investigator , Research support
A. D. Harris, pfizer: Investigator , Research support
S. J. Lawrence, Merck: Consultant , Consulting fee
pfizer: Investigator , Research support
A. Masica, pfizer: Investigator , Research support
L. Lamerato, pfizer: Investigator , Research support
M. Zervos, Pfizer: Principle investigator , Research grant to Henry Ford Hospital
Cerexa: Principle investigator , Research grant to Henry Ford Hospital
Tetraphase: Principle investigator , Research grant to Henry Ford Hospital