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Early mortality in patients with community-acquired pneumonia: causes and risk factors

¹ Infectious Disease, ² Microbiology, and ³ Respiratory Medicine Services, Institute of Biomedical Investigation of Bellvitge (IDIBELL) - Hospital University of Bellvitge, University of Barcelona, L'Hospitalet, Barcelona, Spain.

CORRESPONDENCE: C. Garcia-Vidal, Infectious Disease Service, Hospital University of Bellvitge, Feixa Llarga s/n 08907 L'Hospitalet, Barcelona, Spain. Fax: 34 932607637. E-mail: carolgv75{at}hotmail.com

Keywords: Community-acquired pneumonia, early mortality, Pseudomonas aeruginosa, shock, Streptococcus pneumoniae

Received: September 28, 2007
Accepted May 1, 2008

The first 48 h of evolution of patients with community-acquired pneumonia (CAP) are critical. The aim of the present study was to determine the frequency, causes and factors associated with early mortality in CAP.

Nonimmunocompromised adults hospitalised with CAP were prospectively observed from 1995 to 2005. Early deaths, defined as death due to any cause 48 h after admission, were compared with all patients who survived >48 h. Furthermore, early deaths were compared with late deaths (patients who died >48 h) and with survivors.

Of 2,457 patients, 57 (2.3%) died 48 h after admission. Overall mortality was 7.7%. The main causes of early mortality were respiratory failure and septic shock/multiorgan failure. Independent factors associated with early deaths were increased age, altered mental status at presentation, multilobar pneumonia, shock at admission, pneumococcal bacteraemia and discordant empiric antibiotic therapy.

Currently, early mortality is relatively low and is caused by pneumonia-related factors. It occurs mainly among the elderly and in patients presenting with altered mental status, multilobar pneumonia and septic shock. Pneumococcal bacteraemia and discordant antibiotic therapy, mainly due to lack of coverage against Pseudomonas aeruginosa are also significant risk factors.