Community-acquired pneumonia: elderly patients who survive were at increased risk of dying subsequently

Clinical bottom line (level 1b)

  1. Elderly patients who survived an episode of community-acquired pneumonia were more likely to die in the next 10 years particularly from pneumonia.
Koivula et al: Archives of Internal Medicine 1999; 159: 1550-1555
Expires March 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: town, Finland

4167 patients aged 60 or more. 122 survived an episode of community-acquired pneumonia (diagnosed on chest X-ray) for at least 60 days

Factors studied:
  • comorbidities (cardiovascular disease, pulmonary disease, renal failure, cancer, thyroid dysfunction, connective tissue disease
  • survived community-acquired pneumonia
  • survived community-acquired pneumonia




    • Cox multivariate regression analysis performed on prognostic factors

    100% followed for median 9.2 years
    Outcomes studied:
  • death
  • pneumonia-related death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death median 9.2 years 1979/4167 48%
    (46% to 49%)
    pneumonia-related death median 9.2 years 331/4167 7.9%
    (7.1% to 8.8%)

    prognostic factor for
    death     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    survived community-acquired pneumonia median 9.2 years 1.5
    (1.2 to 1.9)     		5
    (3 to 13)

    prognostic factor for
    pneumonia-related death     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    survived community-acquired pneumonia median 9.2 years 2.1
    (1.3 to 3.4)     		2
    (1 to 9)

    Comments

    1. The patients in this study all lived in a small town in Finland. It may be difficult to apply to a more racially, culturally, economically, socially diverse population.
    2. There is no data to compare the patients who recieved vaccination (n=2873) to the others in terms of mortality.

    Citation

    1. Koivula I, Sten M, Makela PH: prognosis after community-acquired pneumonia in the elderly: a population-based 12-year follow-up study. Archives of Internal Medicine 1999; 159: 1550-1555
    Search Terms:
    Contributor: Chris Ball and Clare Wotton, November 1999
    Reviewer: Wai-Lam Chan

    Clinical Question.
    Patient elderly patients, patients with pneumonia
    Intervention or Exposure survived pneumonia
    Outcome death, pneumonia mortality