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Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

H. Kothe, T. Bauer, R. Marre, N. Suttorp, T. Welte, K. Dalhoff, the Competence Network for Community-Acquired Pneumonia study group
European Respiratory Journal 2008 32: 139-146; DOI: 10.1183/09031936.00092507
H. Kothe
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T. Bauer
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R. Marre
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N. Suttorp
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T. Welte
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K. Dalhoff
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Tables

  • Additional Files
  • Table 1—

    Demographic and clinical data of the study population

    Age groupp-value
    <65 yrs≥65 yrs
    Subjects n12981349
    Age yrs47.2±12.777.1±7.5
    Males/females n716/582770/5790.33
    Body mass index kg·m−225.1±5.525.3±4.50.43
    Smokers44.917.8<0.001
    Body temperature °C37.9±1.237.7±1.1<0.001
    Dyspnoea68.281.7<0.001
    Purulent sputum53.362.3<0.001
    Cough87.084.00.29
    Pleuritic pain49.028.5<0.001
    Pleuritic effusion12.618.3<0.001
    Confusion5.216.4<0.001
    BUN mM5.7±4.79.2±6.3<0.001
    Respiratory frequency breaths·min−119.8±6.520.8±6.6<0.001
    Blood pressure mmHg
     Systolic123.3±19.0134.6±24.4<0.01
     Diastolic74.7±11.875.9±13.6<0.001
    Blood pH7.45±0.077.44±0.06<0.01
    Pa,O2mmHg67.2±17.365.1±16.8<0.05
    Pa,CO2mmHg35.4±8.236.9±8.7<0.05
    Sa,O2 %92.6±6.191.4±5.7<0.01
    Leukocytes cells·nL−112.6±6.213.3±6.1<0.01
    C-reactive protein mg·L−1137.4±127.9139.6±118.60.68
    Glucose mM6.6±2.98.1±3.8<0.001
    • Data are presented as mean±sd or %, unless otherwise indicated. BUN: blood urea nitrogen; Pa,O2: arterial oxygen tension; Pa,CO2: arterial carbon dioxide tension; Sa,O2: arterial oxygen saturation. 1 mmHg = 0.133 kPa.

  • Table 2—

    Distribution of the main respiratory pathogens in patients with community-acquired pneumonia

    Age groupp-value
    <65 yrs≥65 yrs
    Patients n12981349
    Pathogens detected n271268
    Streptococcus pneumoniae %42.143.30.85
    Gram-negative bacilli %3.77.10.17
    Staphylococcus aureus %1.52.20.74
    Haemophilus influenzae %4.83.40.53
    Chlamydia pneumoniae %1.100.26
    Mycoplasma pneumoniae %14.00.70.0005
    Legionella spp. %16.617.50.87
    Respiratory syncytial virus %1.83.70.29
    Influenza virus A %5.914.90.001
  • Table 3—

    Comorbid conditions, residence status and treatment changes

    Age groupp-value
    <65 years≥65 years
    Subjects n12981349
    CURB score0.55±0.731.03±0.89<0.001
    Comorbid condition
     Chronic pulmonary disease30.042.6<0.001
     Chronic heart disease12.847.2<0.001
     Congestive heart failure6.437.9<0.001
     Chronic liver disease3.93.30.46
     Chronic kidney failure2.913.3<0.001
     Cerebrovascular disease4.122.3<0.001
     Other neurological disorder6.610.10.001
     Diabetes mellitus8.328.1<0.001
    Nursing home3.315.2<0.001
    30-day mortality2.210.3<0.001
    Change of antibiotic treatment
     Overall25.432.6<0.001
     Ineffectiveness10.911.60.58
     Sequential therapy8.213.1<0.001
     De-escalation3.84.80.13
     Intolerance1.31.20.86
     Resistance0.71.70.03
    • Data are presented as mean±sd or %, unless otherwise stated. CURB: confusion, urea, respiratory frequency and blood pressure.

  • Table 4—

    Univariate analysis of risk factors for 30-day mortality in community-acquired pneumonia patients

    OR (95% CI)p-value
    Age <65/≥65 yrs5.03 (3.34–7.56)<0.001
    Comorbid condition
     Chronic pulmonary disease1.104 (0.80–1.53)0.560
     Chronic heart disease2.76 (2.01–3.78)<0.001
     Congestive heart failure4.91 (3.56–6.78)<0.001
     Cerebrovascular disease5.91 (4.25–8.22)<0.001
     Other neurological disorder3.86 (2.61–5.69)<0.001
     Chronic liver disease2.98 (1.67–5.29)0.001
     Chronic kidney failure4.22 (2.86–6.22)<0.001
     Diabetes mellitus2.55 (1.83–3.57)<0.001
    Nursing home8.00 (5.66–11.30)<0.001
    CURB score#2.60 (2.10–3.20)<0.001
    Change of antibiotic treatment
     Overall1.30 (0.90–1.83)0.186
     Ineffectiveness2.24 (1.50–3.34)0.001
     Sequential therapy0.46 (0.24–0.94)0.026
     De-escalation0.40 (0.13–1.27)0.159
     Intolerance1.52 (0.46–5.02)0.457
     Resistance0.94 (0.93–0.95)0.258
    • OR: odds ratio; CI: confidence interval; CURB: confusion, urea, respiratory frequency and blood pressure. #: univariate analysis performed as logistic regression; OR and 95% CI shown are per step.

  • Table 5—

    Multivariate analysis of risk factors for 30-day mortality in community-acquired pneumonia patients

    β (95% CI)p-value
    Age <65/≥65 yrs1.84 (1.06–3.18)0.030
    Comorbid condition
     Congestive heart failure1.85 (1.18–2.92)0.007
     Cerebrovascular disease1.84 (1.13–3.00)0.014
     Chronic liver disease4.10 (1.98–8.49)<0.001
    Nursing home2.95 (1.80–4.83)<0.001
    CURB score2.13 (1.69–2.69)<0.001
    Change of antibiotic treatment
     Ineffectiveness1.74 (1.07–2.83)0.027
     Sequential therapy0.26 (0.10–0.62)0.003
    Comorbid condition
     Chronic pulmonary disease0.756
     Chronic heart disease0.523
     Chronic kidney failure0.622
     Diabetes mellitus0.849
     Other neurological disorder0.062
    Change of antibiotic treatment
     Overall0.106
     De-escalation0.080
     Intolerance0.810
     Resistance0.080
    • CI: confidence interval; CURB: confusion, urea, respiratory frequency and blood pressure.

  • Table 6—

    Multivariate analysis of risk factors for 30-day mortality in elderly patients

    β (95% CI)p-value
    CURB1.88 (1.45–2.44)<0.001
    Age1.07 (1.04–1.11)<0.001
    Comorbid condition
     Chronic liver disease4.49 (1.73–11.67)0.020
     Cerebrovascular disease1.79 (1.05–3.04)0.033
    Nursing home2.38 (1.36–4.15)0.002
    Change of antibiotic treatment
     Ineffectiveness1.95 (1.12–3.38)0.018
     Sequential therapy0.23 (0.09–0.61)0.003
    • CI: confidence interval; CURB: confusion, urea, respiratory frequency and blood pressure.

  • Table 7—

    Influence of residence status on outcome-relevant factors

    Residence statusp-value
    Nursing homeHome
    Subjects n2051144
    Age yrs82.3±7.976.1±7.0<0.001
    CURB score1.52±1.010.93±0.83<0.001
    Comorbid condition
     Chronic pulmonary disease31.744.50.001
     Chronic heart disease53.546.10.055
     Congestive heart failure57.434.4<0.001
     Chronic liver disease3.03.31.000
     Chronic kidney failure23.111.6<0.001
     Cerebrovascular disease63.815.0<0.001
     Other neurological disorder28.96.8<0.001
     Diabetes mellitus36.026.50.004
    30-day mortality28.86.9<0.001
    Change of antibiotic treatment
     Overall39.731.40.029
     Ineffectiveness14.111.20.233
     Sequential therapy15.612.70.257
     De-escalation5.54.90.597
     Intolerance1.01.21.000
     Resistance2.01.60.560
    • Data are presented as mean±sd or %, unless otherwise stated. CURB: confusion, urea, respiratory frequency and blood pressure.

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Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment
H. Kothe, T. Bauer, R. Marre, N. Suttorp, T. Welte, K. Dalhoff, the Competence Network for Community-Acquired Pneumonia study group
European Respiratory Journal Jul 2008, 32 (1) 139-146; DOI: 10.1183/09031936.00092507

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Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment
H. Kothe, T. Bauer, R. Marre, N. Suttorp, T. Welte, K. Dalhoff, the Competence Network for Community-Acquired Pneumonia study group
European Respiratory Journal Jul 2008, 32 (1) 139-146; DOI: 10.1183/09031936.00092507
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