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

Eurich, Dean T.; Marrie, Thomas J.; Minhas-Sandhu, Jasjeet K.; Majumdar, Sumit R.

doi:10.1164/rccm.201501-0140oc

Cited by 103 publications

(94 citation statements)

References 29 publications

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“…Pneumonia was the main cause of early death, confirming that hospital admission was reserved for the most severe cases. Later causes of death were attributed mainly to chronic conditions such as vascular disease, and malignancies, not to recurrent pneumonia, a finding consistent with previous studies [13–14, 23–24]. As in other reports, our findings further support the impression that cardiovascular events may play an important part in the long-term outcome of hospital survivors of CAP [25–27].…”

Section: Discussionsupporting

confidence: 92%

“…The difference was greater for in-hospital and 30-day mortality, then dropped to a 1.73-fold increase in one-year mortality. The consistently high all-cause mortality rate for patients with CAP observed in our population reflects the findings of other studies, and may represent an accurate estimate of the mortality risk associated with an episode of CAP among people over 65 [14]. …”

Section: Discussionsupporting

confidence: 85%

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Pneumococcal Conjugated Vaccine Reduces the High Mortality for Community-Acquired Pneumonia in the Elderly: an Italian Regional Experience

et al. 2016

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BackgroundCommunity-acquired pneumonia (CAP) is an important cause of illness and death worldwide, particularly among the elderly. Previous studies on the factors associated with mortality in patients hospitalized for CAP revealed a direct association between the type of microorganism involved, the characteristics of the patient and mortality. Vaccination status against pneumococcal disease was not considered. We conducted a retrospective analysis on the mortality rates after a first hospitalization for CAP in north-east Italy with a view to examining especially the role of anti-pneumococcal vaccination as a factor associated with pneumonia-related mortality at one year.MethodBetween 2012–2013, patients aged 65+ hospitalized with a primary diagnosis of CAP, identified based on International Classification of Diseases, Ninth Revision, Clinical Modification codes 481–486, were enrolled in the study only once. Patients were divided into three groups by pneumococcal vaccination status: 1) 13-valent pneumococcal conjugate vaccine (PCV13) prior to their hospitalization; 2) 23-valent pneumococcal polysaccharide vaccine (PPV23) within 5 years before hospitalization and 3) unvaccinated or PPV23 more than 5 years prior to admission. Gender, age, length of hospital stay and influenza vaccination were considered. Comorbidities were ascertained by means of a properly coded diagnosis. Every patient was followed up for 1 year and the outcome investigated was mortality for any cause and for pneumonia.ResultsA total of 4,030 patient were included in the study; mean age at the time of admission to hospital was 84.3±7.7; 50.9% were female. 74.2% of subjects had at least one comorbidity; 73.7% has been vaccinated against influenza. Regard to pneumococcal vaccine, 80.4% of patients were not vaccinated, 14.5% vaccinated with PPV23 and 5.1% with PCV13. The 1-year survival rates after hospitalization for pneumonia were 83.6%, 85.9% and 89.3% in the unvaccinated, PPV23 and PCV13 groups, respectively. Regression analysis indicated that the risk of death due to pneumonia increased significantly with age (adjusted OR: 1.073; 1.061–1.085), shorter hospital stay (adjusted OR: 0.981; 0.971–0.990), and male gender (adjusted OR: 1.372; 1.165–1.616). The model also confirmed the pneumococcal 13-valent conjugated vaccine as an independent protective factor for mortality-related pneumonia (adjusted OR: 0.599; 0.390–0.921).ConclusionThe main finding of our observational cohort study is a high mortality rate among elderly patients admitted to hospital for pneumonia. The present study suggests a protective role for PCV13 vaccination.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 85%

Pneumococcal Conjugated Vaccine Reduces the High Mortality for Community-Acquired Pneumonia in the Elderly: an Italian Regional Experience

et al. 2016

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“…After deaths directly attributed to pneumonia, the next most common cause of death is cardiovascular with an increased cardiovascular risk persisting out to 5 and 10 years . For this reason there is interest in using cardio‐protective medications such as aspirin and statins to reduce both early and late mortality from CAP.…”

Section: Achieving Best Outcomesmentioning

confidence: 99%

Determining best outcomes from community‐acquired pneumonia and how to achieve them

Hadfield

Bennett

2017

Respirology

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Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical-and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.

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“…Among older adults, survivors of an acute pneumonia hospitalization have higher mortality risks that persist for years following discharge compared with matched patients hospitalized for reasons other than pneumonia (48,128). Increased mortality risks following pneumonia appear to be less dependent on age or acute severity of pneumonia, but strongly influenced by the nature of the preexisting comorbid conditions (48,88,128,343).…”

Section: B Long-term Consequences Of Pneumonia In Adulthoodmentioning

confidence: 99%

Integrative Physiology of Pneumonia

Quinton

Walkey

Mizgerd

2018

Physiological Reviews

190

203

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Pneumonia is a type of acute lower respiratory infection that is common and severe. The outcome of lower respiratory infection is determined by the degrees to which immunity is protective and inflammation is damaging. Intercellular and interorgan signaling networks coordinate these actions to fight infection and protect the tissue. Cells residing in the lung initiate and steer these responses, with additional immunity effectors recruited from the bloodstream. Responses of extrapulmonary tissues, including the liver, bone marrow, and others, are essential to resistance and resilience. Responses in the lung and extrapulmonary organs can also be counterproductive and drive acute and chronic comorbidities after respiratory infection. This review discusses cell-specific and organ-specific roles in the integrated physiological response to acute lung infection, and the mechanisms by which intercellular and interorgan signaling contribute to host defense and healthy respiratory physiology or to acute lung injury, chronic pulmonary disease, and adverse extrapulmonary sequelae. Pneumonia should no longer be perceived as simply an acute infection of the lung. Pneumonia susceptibility reflects ongoing and poorly understood chronic conditions, and pneumonia results in diverse and often persistent deleterious consequences for multiple physiological systems.

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

Abstract: Our results indicate that an episode of CAP confers a high risk of long-term adverse events compared with the general population who have not experienced CAP, and this is irrespective of age.

Cited by 103 publications

References 29 publications

Pneumococcal Conjugated Vaccine Reduces the High Mortality for Community-Acquired Pneumonia in the Elderly: an Italian Regional Experience

Pneumococcal Conjugated Vaccine Reduces the High Mortality for Community-Acquired Pneumonia in the Elderly: an Italian Regional Experience

Determining best outcomes from community‐acquired pneumonia and how to achieve them

Integrative Physiology of Pneumonia

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