Predicting 1-year mortality after hospitalization for community-acquired pneumonia.

Ane Uranga,Urko Aguirre,Pedro P España,Silvia Pascual,Amaia Artaraz,Rosa Diez,Jose M Quintana,Aitor Ballaz,Oliver Schildgen

doi:10.1371/journal.pone.0192750

Ane Uranga, Urko Aguirre + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0192750

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Journal: PloS one	Publication Date: Feb 14, 2018
Citations: 16	License type: CC BY 4.0

Affiliation: Hospital de Galdakao

Abstract

BackgroundCommunity-acquired pneumonia (CAP) is a major public health problem with high short- and long-term mortality. The main aim of this study was to develop and validate a specific prognostic index for one-year mortality in patients admitted for CAP.MethodsThis was an observational, prospective study of adults aged ≥18 years admitted to Galdakao-Usansolo Hospital (Bizkaia, Spain) from January 2001 to July 2009 with a diagnosis of CAP surviving the first 15 days. The entire cohort was divided into two parts, in order to develop a one-year mortality predictive model in the derivation cohort, before validation using the second cohort.ResultsA total of 2351 patients were included and divided into a derivation and a validation cohort. After deaths within 15 days were excluded, one-year mortality was 10.63%. A predictive model was created in order to predict one-year mortality, with a weighted score that included: aged over 80 years (4 points), congestive heart failure (2 points), dementia (6 points), respiratory rate ≥30 breaths per minute (2 points) and blood urea nitrogen >30 mg/dL (3 points) as predictors of higher risk with C-index of 0.76. This new model showed better predictive ability than current risk scores, PSI, CURB65 and SCAP with C-index of 0.73, 0.69 and 0.70, respectively.ConclusionsAn easy-to-use score, called the one-year CAPSI, may be useful for identifying patients with a high probability of dying after an episode of CAP.

Highlights

Community-acquired pneumonia (CAP) is a major public health problem with high morbidity and mortality [1]
A predictive model was created in order to predict one-year mortality, with a weighted score that included: aged over 80 years (4 points), congestive heart failure (2 points), dementia (6 points), respiratory rate !30 breaths per minute (2 points) and blood urea nitrogen >30 mg/dL (3 points) as predictors of higher risk with C-index of 0.76
Short-term mortality rates are high in patients admitted for CAP, but are even higher in those admitted to intensive care units, and up to 50% if there is a need for vasopressors [4]

Summary

Introduction

Community-acquired pneumonia (CAP) is a major public health problem with high morbidity and mortality [1]. Short-term mortality rates are high in patients admitted for CAP, but are even higher in those admitted to intensive care units, and up to 50% if there is a need for vasopressors [4]. The need for hospital admission was related to a higher oneyear mortality rate in patients admitted for any reason [6]. Patients admitted for pneumonia have exhibited higher long-term mortality rates than those admitted for other reasons [7,8]. The older adult population suffers from a greater number of comorbidities, and functional status is often poor Other risk factors, such as male sex, race or patients suffering from healthcare-associated pneumonia (HCAP) are related to increased mortality [1]. Community-acquired pneumonia (CAP) is a major public health problem with high shortand long-term mortality.

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