Aetiology, Clinical Presentation and Outcome in Patients with Community-Acquired Pneumonia Requiring Hospitalisation: A Prospective Study

Abstract

Background. There is paucity of reliable published data from Andhra Pradesh, India regarding aetiology, clinical presentation and outcome in patients with community-acquired pneumonia (CAP) requiring hospitalisation.Methods. We prospectively studied 100 consecutive adult patients admitted with CAP during the period January 2018 to June 2019 at our tertiary care teaching hospital in Tirupati, Andhra Pradesh, South India.Results. Their mean age was 54.4±15.7 years; there were 57 (57%) males. Single aetiology was found in 42% with influenza A (H1N1)pdm09 (12%), Legionella pneumophila (9%) being the most common; more than one concurrent aetiological agents were found in 31%; and no aetiological agent could be established in 27% patients. Mechanical ventilation (both noninvasive ventilation [NIV] and invasive mechanical ventilation [IMV]) were required in 65 patients. NIV was required in 58 patients, of them 38 had recovered; 20 had NIV-failure and required tracheal intubation and IMV. Sixteen patients died; 12 due to CAP and the rest due to other causes. On receiver-operator characteristic (ROC)-curve analysis acute physiology and chronic health evaluation II (APACHE II) score ≥14 (sensitivity 84.5% and specificity 56.3%), pneumonia severity index (PSI) score ≥98 (sensitivity 72.6% and specificity 68.8%) and erythrocyte sedimentation rate (ESR) ≥76 (sensitivity 73.8% and specificity 62.5%) were predictors of death. On multivariable analysis need for IMV (p<0.001) emerged as an independent predictor of death.Conclusions. CAP can present with single or multiple concurrent aetiologies. A trial of NIV can obviate the need for IMV. On multivariable analysis, need for IMV is an independent predictor of death in patients with CAP.