Abstract
There are few data on mortality after discharge with community-acquired pneumonia (CAP). Therefore, we evaluated risk factors for 30-day post-discharge mortality after CAP. We included all patients of the prospective multi-national CAPNETZ study between 2002 and 2018 with (1) hospitalized CAP, (2) survival until discharge, and (3) complete follow-up data. The study endpoint was death within 30 days after discharge. We evaluated risk factors including demographics, comorbidities, admission CAP severity, and laboratory values and treatment-related factors in uni- and multivariable analyses. A total of 126 (1.6%) of 7882 included patients died until day 30 after discharge, corresponding to 26% of all 476 deaths. After multivariable analysis, we identified 10 independent risk factors: higher age, lower BMI, presence of diabetes mellitus, chronic renal or chronic neurological disease (other than cerebrovascular diseases), low body temperature or higher thrombocytes on admission, extended length of hospitalization, oxygen therapy during hospitalization, and post-obstructive pneumonia. By addition these factors, we calculated a risk score with an AUC of 0.831 (95%CI 0.822–0.839, p < 0.001) for prediction of post-discharge mortality. Early post-discharge deaths account for ¼ of all CAP-associated deaths and are associated with patient- and CAP-severity-related risk factors. Additional studies are necessary to replicate our findings in independent cohorts. Study registration: NCT 02139163.
Highlights
Complications and short- or long-term mortality after hospital discharge because of community-acquired pneumonia (CAP) contribute significantly to the burden of this disease [1]
If this number is added to the 350 documented in-hospital deaths within the CAPNETZ cohort (Fig. 1), this corresponds to 26% of all 476 deaths in the study cohort until day 30 after discharge
We found a significant association with the endpoint for need of various kinds of respiratory support during CAP hospitalization as well as for length of hospital stay (LOS), occurrence of a pleural effusion, need of antibiotic treatment change, and for the final diagnosis of post-obstructive pneumonia
Summary
Complications and short- or long-term mortality after hospital discharge because of community-acquired pneumonia (CAP) contribute significantly to the burden of this disease [1]. Whereas long-term mortality after CAP is predominantly comorbidity-related [2, 3], early (within 30 days) post-discharge complications might have potential for CAP-related causes susceptible to specific interventions. Recent population-based German data demonstrated a high mortality increase of 4.7% between in-hospital mortality (17.2%) and 30-day mortality (21.9%) in a cohort of 16.274 hospitalized patients with CAP [4]. From large multicenter cohorts, there are very few data regarding risk factors for early post-discharge complications or mortality of patients that were hospitalized with CAP [7]. Initiate, and tailor optimized patient follow-up and structured discharge interventions to improve post-discharge prognosis, data on specific risk factors are necessary
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