Elsevier

Journal of Infection

Volume 68, Issue 6, June 2014, Pages 534-541
Journal of Infection

Incidence, timing and risk factors associated with 1-year mortality after hospitalization for community-acquired pneumonia

https://doi.org/10.1016/j.jinf.2014.02.006Get rights and content

Summary

Objective

To identify the incidence, causes, timing and risk factors associated with 1-year mortality in CAP patients after hospital discharge.

Methods

Adult patients with CAP who were admitted to a tertiary hospital from 2007 to 2011 were prospectively recruited and followed up for 1 year after hospital discharge.

Results

Of the 1284 patients discharged, 93 (7.2%) died within 1-year of leaving hospital. Sixty eight (73.1%) patients died in the first six months. The main reasons for 1-year mortality after hospital discharge were infectious diseases, mainly pneumonia, followed by acute cardiovascular events. Mortality from infectious diseases was higher during the first 6 months (86.1%), while the number of deaths from cardiovascular causes was stable throughout the months of follow-up. After adjustment for confounders, chronic obstructive pulmonary disease, diabetes mellitus, cancer, dementia, rehospitalization within 30 days of hospital discharge and nursing home were independently associated with 1-year mortality. The incidence of long-term mortality increased >50% when ≥4 risk factors were present (P < .001).

Conclusions

Patients mainly died from infectious diseases and acute cardiovascular events in the first six months after leaving hospital for an acute CAP episode. Certain features may help to identify the risk of long-term mortality in CAP patients.

Introduction

Community-acquired pneumonia (CAP) is one of the main public health problems worldwide.1 In industrialized countries, CAP is a major cause of death and the most frequent cause of mortality among infectious diseases.2

Recent studies have found overall in-hospital mortality rates of 8%–15%.3, 4 Importantly, it has been shown that hospitalization for this infection is associated with high long-term mortality compared with other major medical conditions.5 The frequency of long-term mortality reported in these studies ranged from 11% to 53%.5, 6, 7, 8, 9 The increase in long-term mortality appears to be related to several aspects, mainly chronic comorbid conditions.5, 7 However, the prognostic factors associated with 1-year mortality after an episode of CAP are not well known.10 Notably, information about causes of 1-year mortality is also scarce and data on the timing of death are lacking.

Therefore, there is a significant interest in gaining further insight into the relationship between CAP and 1-year mortality for patients who survive to the initial acute event. A better understanding of factors related with this complication in patients with CAP may have implications for patient care. Therefore, this is an important issue that requires comprehensive evaluation.11

This study of a large prospective cohort of hospitalized adult patients with CAP aimed to identify the incidence, causes, timing and risk factors associated with 1-year mortality after hospital discharge.

Section snippets

Setting and study design

The observational study was carried out in a 700-bed university hospital for adults in Barcelona, Spain that serves an area of 1.1 million inhabitants and admits approximately 24,000 patients per year. All adult patients >17 years of age with CAP who were admitted to the hospital from 1 January 2007 to 31 December 2011 were prospectively recruited and followed up. Patients with neutropenia, immunoglobulin deficiencies, HIV infection, transplantation or splenectomy, as well as those who were

Results

During the study period, 1405 non-immunosuppressed adults with CAP were hospitalized. Two hundred and fourteen (15.2%) patients died during the 1-year follow-up, of whom 121 died during hospitalization. Of the 1284 patients discharged from the hospital, 93 (7.2%) died within 1-year of leaving hospital.

Discussion

In this prospective study of a large cohort of hospitalized patients with CAP, we found that a considerable number of patients died within 1-year after discharge, mainly in the first six months. The major causes of mortality were infectious diseases or acute cardiovascular events. The risk factors independently associated with 1-year mortality after hospital discharge were comorbidity conditions, rehospitalization within 30 days of hospital discharge and nursing home residence.

In the present

Funding

This work was supported by the Fondo de Investigación Sanitaria de la Seguridad Social (grant 11/01106) and Spain's Ministerio de Economía y Competitividad, Instituto de Salud Carlos III, co-financed by the European Regional Development Fund “A way to achieve Europe” ERDF and the Spanish Network for Research in Infectious Diseases (REIPI RD12/0015). Dr. Viasus is the recipient of a research grant from the REIPI. Dr. Garcia-Vidal is the recipient of a Juan de la Cierva research grant from the

Contributorship

All investigators had given final approval of the submitted manuscript.

Study concept and design: Adamuz, Viasus, Garcia-Vidal, Isla, Dorca, and Carratalà.

Acquisition of data: Adamuz, Viasus, Jiménez Martínez, and Garcia-Vidal.

Analysis and interpretation: Adamuz, Viasus and Carratalà.

Drafting the manuscript: Adamuz, Viasus, and Carratalà.

Critical revision of the manuscript for important intellectual content: Jiménez Martínez, Garcia-Vidal, Isla and Dorca.

Study supervision: Viasus, Carratalà and

Conflict of interest statement

None of the authors have conflicts of interest to disclose.

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