Cause-specific long-term mortality rates in patients recovered from community-acquired pneumonia 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 comorbidityrelated, 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.

Potential causes of increased long-term mortality after pneumonia

“…Another study by KAPLAN et al [6] of 158,960 Medicare patients with community-acquired pneumonia who were matched to 794,333 patients hospitalised for other conditions demonstrated a 1-yr mortality of 40.9% for the pneumonia group versus 24.9% for the controls. Several other studies support the concept that there is markedly increased mortality for up to several years afterwards for those that initially survive an episode of pneumonia [7][8][9][10][11][12].…”

Treatment with anti‐inflammatory drugs in community‐acquired pneumonia

“…Thirdly, most studies have evaluated 30-day pneumonia mortality as the primary endpoint. Recent studies showed that a clinically important number of subjects with pneumonia have a cardiovascular event within 90 days of hospital admission [44,45]. It is conceivable that the observed benefits of statins do not represent anti-inflammatory effects during the acute phase of pneumonia, but are mainly the result of a lack of statin treatment being associated with cardiovascular death after pneumonia.…”

Cardiotoxicity during Invasive Pneumococcal Disease

“…Streptococcus pneumoniae (the pneumococcus) is the most frequent cause of CAP, bacteremia, and sepsis (18). Pneumococcal infection is associated with greater disease severity and increased risk of death compared with other causes of pneumonia; in one study, the mortality risk was almost threefold higher (19). Infection with S. pneumoniae has also been directly associated with adverse cardiac events.…”

“…Infection with S. pneumoniae has also been directly associated with adverse cardiac events. In a 2007 study by Musher and colleagues (20), 19.4% of 170 admitted adult patients experienced some form of an adverse cardiac event; most importantly, those who experienced an adverse cardiac event during pneumonia were at significantly higher risk for death than those with pneumococcal pneumonia alone. Herein, we review the pathogenic mechanisms by which S. pneumoniae directly inhibits cardiac contractility.…”