Fatal severe community-acquired pneumonia: risk factors, clinical characteristics and medical errors of hospital patients

Abstract

Community-acquired pneumonia (CAP) is the most common disease and potentially life-threatening infection in the worldwide. In the Nizhny Novgorod region, no analysis of the causes of mortality and medical errors of severe CAP patients.
 Aim. To analyze the patients structure who died severe CAP in hospitals of the Nizhny Novgorod region, to identify the leading risk factors, to assess the clinical characteristics of fatal severe CAP and medical errors according to medical records of patients from 20152016.
 Materials and methods. This was a retrospective study of medical records of 139 patients with fatal severe CAP from medical organizations of the Nizhny Novgorod region. The 72 patients died in 2015. The mortality rate from pneumonia was 67 cases in 2016.
 Results. The key predictors of the fatal severe CAP in patients of the Nizhny Novgorod region identified: socio-demographic status (men of working age, unemployed, smoking, alcohol and drug dependence), late treatment and hospitalization, tachypnea, hypotension, tachycardia, confusion, leukocytosis or leukopenia, thrombocytopenia, anemia, hyperglycemia, bilateral lung damage, pleural effusion, acute respiratory failure. The leading medical errors in fatal CAP were incorrect assessment of the severity of the patients condition, untimely CAP, non-monitoring of SpO2 on the first day of hospitalization, late transfer of patients to the intensive care unit, there was no influenza therapy, inadequate starting antibacterial therapy.
 Conclusion. The main ways to avoid or minimize medical errors and reduce the mortality of patients with TVP is strict adherence to clinical recommendations, active preventive measures, diagnosis and treatment of chronic diseases.

Influence of overweight and obesity on the mortality of hospitalized patients with community-acquired pneumonia

“…Nevertheless, the risk of developing CAP in obese individuals is lower than in the general population[ 3 , 46 ]. BMI and the prognosis of pneumonia have recently emerged as a subject of increased and intense study[ 19 - 26 ].…”

“…The incidence of CAP ranges from 10.6 to 44.8 cases per 1000 person-years and increases with age[ 2 ]. CAP risk factors include age, smoking, chronic comorbidities (such as diabetes mellitus and chronic lung, renal, heart, or liver disease), orodental/periodontal disease, treatment with proton pump inhibitors, prescription opioids, and high alcohol consumption[ 3 - 5 ]. Pathogens that cause CAP include respiratory viruses, Streptococcus pneumoniae ( S. pneumoniae ), Mycoplasma pneumoniae , Haemophilus influenzae , Moraxella catarrhalis , Chlamydophila pneumoniae , Legionella species, Staphylococcus aureus , and Gram-negative rods[ 6 , 7 ].…”