COPD is associated with increased mortality in patients with community-acquired pneumonia

¹ From the VERDICT, Audie L Murphy VA Hospital; and Pulmonary and Critical Care Medicine
² From the VERDICT, Audie L Murphy VA Hospital; and the University of Texas Health Science Center at San Antonio, Divisions of General Medicine
³ Pulmonary and Critical Care Medicine

^* To whom correspondence should be addressed. E-mail: restrepom{at}uthscsa.edu.

	Abstract

Patients with chronic obstructive pulmonary disease (COPD) that develop community-acquired pneumonia (CAP) may have worse clinical outcomes. However COPD is not included as a distinct diagnosis in validated instruments that predict mortality in patients with CAP. Our aim was to evaluate the impact of COPD as a co-morbid condition on 30- or 90- day mortality in CAP patients.

A retrospective, observational study was conducted at two hospitals. Eligible patients had a discharge diagnosis and radiologic confirmation of CAP.

In 744 patients with CAP, 215 patients had a co-morbid diagnosis of COPD and 529 did not have COPD. The COPD group had a higher mean pneumonia severity index score (PSI, 105±32 vs. 87±34; p=0.05), and were admitted to the intensive care unit more frequently (25% vs. 18%; p=0.04). After adjusting for severity of disease and processes of care, CAP patients with COPD had significantly higher 30-day mortality (hazard ratio=1.32, 95% confidence interval 1.01-1.74) and 90-day mortality (hazard ratio=1.34, 95% confidence interval 1.02-1.76) versus non-COPD patients.

COPD patients hospitalized with CAP had higher 30- and 90- day mortality when compared to patients without COPD. COPD should be evaluated for inclusion CAP prediction instruments.

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