Abstract
BackgroundThe prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient’s comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities.MethodsData on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates.ResultsFrom 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84–0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities.ConclusionsNot only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.
Highlights
Community-acquired pneumonia (CAP) are a major cause of morbidity and mortality, especially in elderly [1, 2]
Some comorbidities are recognized risk factors for pneumococcal community-acquired pneumonia (CAP) (P-CAP) occurrence and severity, i.e., short-term prognosis; those associated with an intermediate risk, generally in immunocompetent patients, are termed at risk (AR) comorbidities, while those generally associated with immunosuppression or immunodeficiency, i.e., patients with cancer or other causes of immunosuppression or immunodeficiency, are termed high risk (HR) comorbidities [7, 8]
Study objectives This study aimed at evaluating the impact of comorbidities identified as risk factors for P-CAP occurrence and severity, on short-term outcomes (ICU admission, mortality during the initial hospital stay) and on 1-year in-hospital mortality, in an exhaustive population of patients aged 50 years or more who are hospitalized in France with CAP, of pneumococcal origin or not
Summary
Community-acquired pneumonia (CAP) are a major cause of morbidity and mortality, especially in elderly [1, 2]. The associated burden increases with the ageing of population [3]. Some comorbidities are recognized risk factors for pneumococcal CAP (P-CAP) occurrence and severity, i.e., short-term prognosis; those associated with an intermediate risk, generally in immunocompetent patients, are termed at risk (AR) comorbidities, while those generally associated with immunosuppression or immunodeficiency, i.e., patients with cancer or other causes of immunosuppression or immunodeficiency, are termed high risk (HR) comorbidities [7, 8]. The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient’s comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities
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