Prospective Study of Prognostic Factors in Community‐Acquired Bacteremic Pneumococcal Disease in 5 Countries

Kalin, Mats; Örtqvist, Åke; Almela, Manuel; Aufwerber, Ewa; Dwyer, Richard; Henriques, Birgitta; Jorup, Christina; Julander, Inger; Marrie, Tom; Mufson, Maurice A.; Riquelme, Raúl; Thalme, Anders; Torres, Antônio; Woodhead, Mark

doi:10.1086/315760

Cited by 161 publications

(157 citation statements)

References 28 publications

(27 reference statements)

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“…Our findings agree with the limited data available on the outcome of pneumococcal bacteremia specifically in patients with diabetes (1)(2)(3)(11)(12)(13)(14). Watanakunakorn et al (1) showed that an association between diabetes and increased mortality in 385 patients with pneumococcal bacteremia disappeared after adjustment for higher age and comorbidity in the diabetic group.…”

Section: Statistical Analysessupporting

confidence: 91%

Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia

et al. 2004

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OBJECTIVE -Patients with diabetes may carry a higher case fatality of invasive pneumococcal infection compared with nondiabetic patients due to decreased immunity, risk of metabolic derangement, or angiopathy. We conducted a population-based cohort study to assess the impact of diabetes on mortality within 90 days in patients with pneumococcal bacteremia.RESEARCH DESIGN AND METHODS -All patients with community-acquired pneumococcal bacteremia in North Jutland County, Denmark, from January 1992 to December 2001 were retrieved from the County Bacteremia Registry. Using civil registry numbers, patients with diabetes were identified by record linkage with the County Prescription Database (for antidiabetic drugs) and the County Hospital Discharge Registry. Mortality within 90 days was determined through the Central Population Registry. Mortality rates were compared for diabetic and nondiabetic patients and adjusted for sex, age, and comorbidity.RESULTS -Among 628 patients aged Ͼ15 years with community-acquired pneumococcal bacteremia, 63 (10.0%) had diabetes. The diabetic patients were slightly older (median age 71.7 years) than the nondiabetic patients (67.0 years), and the proportion of patients with comorbidity was higher in the diabetic group (59 vs. 46%). Mortality in diabetic patients compared with nondiabetic patients was 11.1 vs. 16.5% after 30 days and 16.0 vs. 19.5% after 90 days, respectively. After adjustment for sex, age, and comorbidity, the mortality rate ratio for diabetic patients was 0.6 (95% CI 0.3-1.2) compared with the nondiabetic patients.CONCLUSIONS -Diabetic patients with community-acquired pneumococcal bacteremia appear not to have a higher case fatality than nondiabetic patients. Diabetes Care 27:70 -76, 2004P neumococcal bacteremia is a lifethreatening disease, with in-hospital case fatality estimated at 12-36% (1-3). Advanced age and comorbidity have been associated with fatal outcome. Currently, the prevalence of type 2 diabetes is rising rapidly in many countries due to population aging and increasing prevalence of obesity (4). Patients with diabetes may carry a higher case fatality of invasive pneumococcal disease than nondiabetic patients (5,6) due to risk of metabolic derangement caused by severe infection per se (7), decreased immunity (8), generally decreased tissue oxygenation, or pulmonary microangiopathic changes (9). Moreover, diabetes is associated with a high prevalence of adverse prognostic factors for pneumococcal bacteremia, including old age and comorbidity.Data are sparse concerning the outcome of invasive pneumococcal infection in patients with diabetes (10). Previous case series of pneumococcal bacteremia (1,2,11-14) have been hampered by small numbers of diabetic patients, cohorts from specialized hospitals, or lack of follow-up after hospital discharge. In the present population-based cohort study, we examined whether patients with diabetes suffer from a higher case fatality within 90 days after an episode of community-acquired pneumococcal bacteremia compared with pa...

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Section: Statistical Analysessupporting

confidence: 91%

Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia

et al. 2004

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“…However, our findings showed that much of the mortality increase associated with heart failure disappeared after controlling for age and comorbidity. Our adjusted MRR of 1.40 was comparable to estimates from the few recent studies reporting multivariable-adjusted pneumonia mortality specifically for heart failure, i.e., a study of U.S. Medicare recipients (adjusted in-hospital mortality relative risk=1.53 (95% CI 1.47-1.59)) 11 and in a multinational study of communityacquired pneumococcal bacteremia (adjusted mortality OR=1.3, p-value>0.5; CI not given) 27 .…”

Section: Discussionsupporting

confidence: 62%

The Impact of Pre-existing Heart Failure on Pneumonia Prognosis: Population-based Cohort Study

et al. 2008

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“…Mortality in these patients has been reported to range from 21% to 58% [2]. Prior investigations have shown that the requirement for mechanical ventilation is associated with increased mortality compared with nonventilated patients [3,4]. There are numerous studies evaluating clinical outcomes of patients with community-acquired pneumonia [2], but these studies included an overall population and the outcome of the subgroup of patients requiring mechanical ventilation has not been evaluated in detail.…”

Section: Introductionmentioning

confidence: 99%

Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation

Tejerina

Frutos‐Vivar

Restrepo

et al. 2005

Journal of Critical Care

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Purpose: To evaluate the variables associated with mortality of patients with community-acquired pneumonia who require mechanical ventilation and to determine the attributable morbidity and intensive care unit (ICU) mortality of community-acquired pneumonia. Material and Methods: Retrospective cohort study carried out in 361 ICUs from 20 countries including 124 patients who required mechanical ventilation on the first day of admission to the hospital due to acute respiratory failure secondary to severe community-acquired pneumonia. To assess the factors associated with outcome, a forward stepwise logistic regression analysis was performed, and to determine the attributable mortality of community-acquired pneumonia, a matched study design was used. Results: We found 3 independent variables significantly associated with death in patients with community-acquired pneumonia requiring mechanical ventilation: simplified acute physiological score greater than 45 (odds ratio, 5. Keywords:Community-acquired pneumonia; Mechanical ventilation; Intensive care unit Journal of Critical Care (2005) 20, 230 -238 1.1-4.0]). There was no statistically significant difference in ICU mortality among patients with or without community-acquired pneumonia (32% vs 35%; P = .59). Conclusions: Community-acquired pneumonia needing mechanical ventilation is not a disease associated with higher mortality. The main determinants of patient outcome were initial severity of illness and the development of shock and/or acute renal failure. D

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Prospective Study of Prognostic Factors in Community‐Acquired Bacteremic Pneumococcal Disease in 5 Countries

Cited by 161 publications

References 28 publications

Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia

Diabetes and Outcome of Community-Acquired Pneumococcal Bacteremia

The Impact of Pre-existing Heart Failure on Pneumonia Prognosis: Population-based Cohort Study

Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation

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