Cause‐specific long‐term mortality rates in patients recovered from community‐acquired pneumonia as compared with the general Dutch population

Abstract

Insights into long-term mortality, especially into the cause of death after initial recovery from an episode of community-acquired pneumonia (CAP), may help in determining optimal preventive measures in such patients. Prospective observational cohort studies were conducted to compare cause-specific long-term mortality rates for 356 patients who had recovered from CAP with those of the general Dutch population (16.3 million) between 2003 and 2007. The Dutch Municipal Public Records Database and death certificates were used to determine cause-specific mortality rates up to 7 years after discharge. In patients who had recovered from CAP, cumulative 1-year, 5-year and 7-year mortality rates were 17%, 43% and 53%, respectively, as compared with 4%, 19% and 24% for an age-matched and sex-matched population reference cohort. Overall, patients who had recovered from CAP had significantly higher long-term mortality than matched population controls (rate ratio (RR) 3.6; p <0.001). In the years after an episode of CAP, malignancy (27%), chronic obstructive pulmonary disease (COPD) (19%) and cardiovascular disease (16%) were the most frequent causes of death. Only 6% died of pneumonia, as compared with 3.2% in the general population. After initial recovery from an episode of CAP, long-term mortality rates are more than three times as high as in the general population. The causes of long-term mortality were mostly comorbidity-related, and significantly different from those in the general population. After an episode of CAP, optimization of treatment of comorbidities, such as treatment for COPD, might improve long-term survival rates.

Ten-Year Mortality after Community-acquired Pneumonia. A Prospective Cohort

“…patients from a RCT or a single centre hospitalized veteran affairs population) and did not include non-hospitalized CAP patients. (17)(18)(19) Our data also suggest that the mortality rate among those who survive the initial event is substantially higher compared controls, even after accounting for mortality during the acute event, which has not been previously reported. Moreover, our analyses also suggest that the survival curves for CAP patients relative to controls continue to worsen and in fact are accelerated over the longer term relative to the general population.…”

“…(19) To our knowledge, this is the longest and largest outcomes study of patients with pneumonia reported to date. Although several short term (1,3,(9)(10)(11)(12), as well as intermediate (1 year) (14,15,19) to longer term (5-7·5 years) outcomes studies (6,17,18) have been conducted most have not used controls to determine if CAP truly increases the risk of morbidity and mortality relative to a control population (1, 3, 6, 9-12, 14, 15, 19) and of the two studies which included controls, both were highly selected populations (e.g. patients from a RCT or a single centre hospitalized veteran affairs population) and did not include non-hospitalized CAP patients.…”

“…For CAP inpatients, studies have reported 1-year mortality rates of 17% to 40% (14)(15)(16) and longer term mortality (5 or 7 years) rates >50%. (6,17,18) Key study limitations have been the inability to assess the impact of pneumonia relative to a control population without pneumonia (6,14,15,19) and highly selected samples (cohorts derived from trial participants (18) or from hospitalized patients from a single medical center). (17) The other key limitation has been a focus on inpatients who survive pneumonia; to our knowledge, there are no studies that have assessed the long-term prognosis for mortality and re-hospitalization associated with an episode of CAP managed on an outpatient basis.…”

The management of community-acquired pneumonia in the elderly

“…The mortality was considerably higher than that of either the general population or control patients hospitalized for reasons other than CAP. Bruns and colleagues showed that causes of death in the years following an episode of CAP were mainly related to comorbidities (malignancy 27%, respiratory diseases 27% [COPD 19%], and vascular diseases 16%), and not attributable to recurrent pneumonia [79]. …”

The impact of multimorbidity on short-term events in patients with community-acquired pneumonia: prospective cohort study

“…10,11 Furthermore, some studies suggest CAP may be associated with long-term sequelae such as ongoing M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 respiratory problems, 12 cardiac complications, or other adverse effects, 13 and fully half of adults that survive a pneumonia hospitalization will be dead within 5 years. 14 Even though the impact of single comorbid conditions on downstream adverse events in patients with CAP has been studied (e.g., the role of COPD in patients with CAP), as has the effect of multimorbidity in patients with chronic conditions such as diabetes or heart failure, there is scarce literature on the impact of multimorbidity in patients with acute conditions.…”