Abstract
BackgroundThe sustained health-related quality-of-life of patients surviving community-acquired pneumonia has not been accurately quantified. The aim of the current study was to quantify differences in health-related quality-of-life of community-dwelling elderly with and without community-acquired pneumonia during a 12-month follow-up period.MethodsIn a matched cohort study design, nested in a prospective randomized double-blind placebo-controlled trial on the efficacy of the 13-valent pneumococcal vaccine in community-dwelling persons of ≥65 years, health-related quality-of-life was assessed in 562 subjects hospitalized with suspected community-acquired pneumonia (i.e. diseased cohort) and 1145 unaffected persons (i.e. non-diseased cohort) matched to pneumonia cases on age, sex, and health status (EQ-5D-3L-index). Health-related quality-of-life was determined 1–2 weeks after hospital discharge/inclusion and 1, 6 and 12 months thereafter, using Euroqol EQ-5D-3L and Short Form-36 Health survey questionnaires. One-year quality-adjusted life years (QALY) were estimated for both diseased and non-diseased cohorts. Separate analyses were performed for pneumonia cases with and without radiologically confirmed community-acquired pneumonia.ResultsThe one-year excess QALY loss attributed to community-acquired pneumonia was 0.13. Mortality in the post-discharge follow-up year was 8.4% in community-acquired pneumonia patients and 1.2% in non-diseased persons (p < 0.001). During follow-up health-related quality-of-life was persistently lower in community-acquired pneumonia patients, compared to non-diseased persons, but differences in health-related quality-of-life between radiologically confirmed and non-confirmed community-acquired pneumonia cases were not statistically significant.ConclusionsCommunity-acquired pneumonia was associated with a six-fold increased mortality and 16% lower quality-of-life in the post-discharge year among patients surviving hospitalization for community-acquired pneumonia, compared to non-diseased persons.Trial registrationClinicalTrials.gov, NCT00812084.
Highlights
The sustained health-related quality-of-life of patients surviving community-acquired pneumonia has not been accurately quantified
Matching was based on age, sex, and EQ-5D-3L-index collected at vaccination, implying that health status of people with suspected pneumonia and their matched non-diseased subjects was similar at the time of vaccination
Despite adequate matching on three criteria, non-diseased subjects had fewer comorbidities, were higher educated and were more often from the south of the Netherlands than pneumonia cases (Table 1)
Summary
The sustained health-related quality-of-life of patients surviving community-acquired pneumonia has not been accurately quantified. Form (36) Health survey [11] (referred hereafter as SF36), and Honselmann et al [10] determined the HrQol at one-year post-discharge using the Euroqol EQ5D-3L instrument [12] (referred hereafter as EQ5D) in patients that had survived an episode of pneumonia and/or sepsis for which admission to intensive care was needed. These studies were all descriptive, and none of these studies quantified the excess quality-adjusted lifeyears (QALY) lost due to CAP in comparison with nondiseased persons (i.e. no pneumonia). Possible HrQol differences between radiologically confirmed and radiologically non-confirmed CAP cases were investigated
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