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Medium-Term Survival after Hospitalization with Community-Acquired Pneumonia

Department of Medicine, University of Western Australia, and Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia; and Physicians Research Network, Methodist Le Bonheur Healthcare, and Clinical Research, Methodist Healthcare, Memphis, Tennessee

Correspondence and requests for reprints should be addressed to Grant W. Waterer, M.B.B.S., F.R.A.C.P., School of Medicine and Pharmacology, University of Western Australia, and Department of Respiratory Medicine, Royal Perth Hospital, G.P.O. Box X2213, Perth 6847, Western Australia, Australia. E-mail: waterer{at}cyllene.uwa.edu.au

An episode of community-acquired pneumonia (CAP) has been suggested to predict greater than expected mortality after discharge from hospital. We ascertained the survival status as of December 2002 of a cohort of patients with CAP identified prospectively between November 1998 and June 2001. Cox regression analysis was used to examine the impact of demographic factors, comorbid illnesses, and CAP severity on subsequent mortality. Of 378 CAP survivors we ascertained the survival status of 366 (96.9%), 125 (34.1%) of whom had died. The mean length of follow-up was 1,058 days (range, 602–1,500 days). Independent predictors of mortality were increasing age (p < 0.001), comorbid cerebrovascular (p = 0.002) and cardiovascular (p = 0.023) disease, an altered mental state (p < 0.001), a hematocrit of less than 35% (p = 0.035), and increasing blood glucose level (p = 0.025). In 41- to 80-year-olds without significant comorbidities there was a trend to greater than expected mortality. In conclusion, an episode of CAP in young adults without significant comorbid illnesses does not appear to be an adverse prognostic marker of medium-term survival. The trend to greater than expected mortality in patients over 40 years of age needs further study and physicians should be particularly alert for underlying life-limiting disease processes in patients presenting with acute confusion or a hematocrit of less than 35%.

Key Words: hospitalization • pneumonia, survival long-term

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