Community-acquired pneumonia: a twentieth of patients died.

Clinical bottom line (level 1b-)

  1. A twentieth of patients in Britain admitted to hospital with community-acquired pneumonia died.
Research Committee of the British Thoracic Society and Public Health Laboratory Service: Quarterly Journal of Medicine 1987; 239: 195-220
Expires March 2003

The study

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

Setting: 25 hospitals, UK

511 patients (aged mean 48 years, 61% male) community-acquired pneumonia, defined as an acute illness with radiological pulmonary shadowing which was either at least segmental or present in more than one lobe, and which was neither pre-existing nor of other known cause.

Excluded if
  • aged <15 or >74 years old
  • pneumonia not main reason for admission or was an expected terminal event
  • pneumonia was distal to bronchial obstruction due to a foreign body or carcinoma
  • pneumonia due to pulmonary tuberculosis
  • failure to return for further clinical, radiological or microbiological follow-up


    • Just under a half of patients had received antibiotics before admission.

    Multiple regression or linear logistic regression analyses were performed to adjust for confounding factors.

    69% followed for 6 weeks
    Outcomes studied:
  • mortality

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    mortality 6 weeks 26/453 5.74%
    (3.60% to 7.88%)

    • Independent variables for mortality are age, no alcohol, no chest pain, no vomiting, respiratory rate, diastolic hypotension and raised blood urea level (>7 mmol/L) (all at p<0.05 or better).

    Comments

    1. Although independent prognostic factors were given, no odds ratios were stated, and it there was no indication of whether the factor increased or decreased the risk of mortality.
    2. The 25 hospitals were selected because of the presence on the staff of an interested physician and microbiologist.

    Citation

    1. Research Committee of the British Thoracic Society , and Public Health Laboratory Service : Community-acquired pneumonia in adults in British hospitals in 1982-1983: A survey of aetiology, mortality, prognostic factors and outcome.. Quarterly Journal of Medicine 1987; 239: 195-220
    Search Terms: community-acquired pneumonia and prognosis in Medline
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient community-acquired pneumonia
    Intervention or Exposure presence of risk factors
    Comparison absence of risk factors
    Outcome mortality