Chest
Volume 138, Issue 2, August 2010, Pages 279-283
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Original Research
Pneumonia
Decrease in Long-term Survival for Hospitalized Patients With Community-Acquired Pneumonia

https://doi.org/10.1378/chest.09-2702Get rights and content

Background

The association of hospitalization because of community-acquired pneumonia (CAP) and long-term survival has not been fully examined. We measured the long-term survival of hospitalized patients with CAP adjusted for the effects of comorbidities.

Methods

A cohort of adult patients admitted to the medical services of the Veterans Affairs Medical Center, Louisville, Kentucky, was retrospectively examined. A Kaplan-Meier survival curve was constructed to assess the effect of CAP admission status on patient survival. A Cox proportional hazards regression model included comorbidities as predictors and time to death as the outcome in the construction of a modified Charlson Comorbidity Index (mCCI). The mCCI was internally validated to evaluate the predictability of patient survival. The mCCI and age > 65 years were included as potential confounders in a final Cox proportional hazards regression model with CAP admission status as the main predictor and time to death as the outcome.

Results

CAP was identified in 624 (9%) out of 6,971 patients. The Kaplan-Meier survival curve showed a significantly shorter survival among patients with CAP than those without CAP (P < .0001). The internal validation of the mCCI showed that patients were more likely to die as the mCCI increased (P < .0001). The Cox proportional hazards regression modeling the association between time to death and CAP admission after adjusting for elderly age and the mCCI showed that hospitalization due to CAP was a statistically significant predictor of decreased survival (hazard ratio, 1.4; 95% CI, 1.2-1.5; P < .0001).

Conclusion

There is a decreased long-term survival among hospitalized patients with CAP after adjusting for comorbidities and aging. Future research to understand the pathophysiology of the long-term CAP outcomes is necessary to develop treatment strategies.

Section snippets

Study Design and Study Population

This was a retrospective, observational study of a cohort of adult patients admitted to the Veterans Affairs Medical Center of Louisville, Kentucky, from June 1, 2001, to November 26, 2006. Patients were included into the study if they were admitted to the hospital for any medical condition. Patients admitted for surgical conditions or psychiatric conditions were excluded. This cohort was divided into two groups: group 1, CAP(+), were patients hospitalized with a diagnosis of CAP during the

Results

From a total of 6,971 patients, definitive CAP was identified in 624 patients (9%). Characteristics of CAP(+) and CAP(−) patients are shown in Table 1. CAP(+) patients were more likely to be elderly (67% vs 49%, P < .0001) and have a higher mCCI (2.0 vs 1.4, P < .0001) as compared with CAP(−) patients.

The Kaplan-Meier survival curve comparing CAP(+) vs CAP(−) showed a progressive decline in survival of both groups of patients (Fig 1). The survival was significantly lower among CAP(+) patients

Discussion

In this study, we documented a significant decrease in survival for hospitalized patients with CAP over a 7.5-year average follow-up. This shorter survival of patients with CAP remained significant after adjustment for age and comorbidities when compared with patients hospitalized during the same period of time for medical problems other than CAP.

Our study design and results have some differences from others previously reported.3, 4, 5, 6, 8, 9, 10, 11 Our study included a comorbidity index

Acknowledgments

Author contributions: All authors provided critical revision of the manuscript and final approval for publication.

Dr Bordon: contributed to study concept and design, interpretation, drafting of the manuscript, and study supervision.

Mr Wiemken: contributed to statistical analysis, interpretation, and drafting of the manuscript.

Dr Peyrani: contributed to interpretation and drafting of the manuscript.

Dr Paz: contributed to data collection.

Dr Gnoni: contributed to data collection.

Dr Cabral:

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