Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia

Abstract

Background: Although patients admitted to hospital for community-acquired pneumonia (CAP) experience substantial short-term mortality following hospital discharge, few studies have focused on identifying factors that predict mortality after admission to hospital in this population. The objective of this study was to develop and validate a prognostic index for 90-day mortality after hospital discharge among patients with CAP. Results: In the derivation cohort, three factors were independently associated with 90-day mortality: preillness functional status, Charlson index (composite measure of co-morbid illnesses) and severity on admission. Mortality at 90 days was 0.7% in the low-risk group, 3.5% in the intermediate-risk group and 17.2% in the highrisk group. In the validation cohort, 90-day mortality in the three groups was 0.6%, 3.9% and 19.6%, respectively. Compared with the low-risk group, the odds ratio for mortality was 43.5 for the high-risk group. The risk categories showed an area under the receiver operating characteristic curve of 0.79 in the derivation cohort and 0.82 in the validation cohort. Conclusions: The prognostic index accurately stratifies patients admitted to hospital for CAP into low-, intermediate-and high-risk groups for 90-day mortality on discharge. The use of this index could help clinicians improve outcomes in this vulnerable population by targeting specific interventions to each group.With more than 5 million cases occurring annually in the USA alone, community-acquired pneumonia (CAP) is a leading cause of hospital admissions as well as morbidity and mortality. Numerous investigations have yielded important information about factors that influence the evolution and treatment of CAP during hospitalisation.

Predictors of In-Hospital vs Postdischarge Mortality in Pneumonia

“…Marrie and Wu 7 found several factors that discriminated between early and late in-hospital mortality. Like Capelastegui et al, 13 they found that baseline functional status was highly associated with later mortality.…”

Functional status determined by Barthel Index predicts community acquired pneumonia mortality in general population

“…In a prospective observational study which analyzes factors that predict in-hospital mortality among 3043 patients with CAP who require hospitalization, mortality was 1.4 higher in patients who needed a wheelchair and 4 times greater in bed-ridden patients than in those who did not require any help. 21 Capalastegui et al 22 developed a prognostic index for 90-day mortality after hospital discharge among patients with CAP, they observed that three factors were independently associated with 90-day mortality: pre-illness functional status, co-morbid illnesses and severity on hospital admission. In our geographical area, a multicenter prospective study 18 on patients with CAP, over 70 years and with limited functional capacity was carried out; the authors analyzed whether the place of residence (nursing homes or community) was an independent prognostic factor; they concluded that when the patients' functional capacity was poor, the place of residence was irrelevant.…”

“…22 All patients who were diagnosed with CAP in the ED during one year were included, thus avoiding any possible selection bias; all the prognostic risk factors for patients with CAP were fully evaluated. However, this study has also several limitations: some patients with CAP are cared by family doctors and may not be referred to hospital, however, these are usually less severe cases of CAP; the rate of admittance to hospital was very high, higher than in other studies, the primary care doctors may have referred to our hospital only patients with severe CAP or with problems in complying with treatment; finally this is a observational study, so we can only suggest an association between poor functional status and mortality in patients with CAP.…”

The impact of an early chest radiograph on outcome in patients hospitalised with community-acquired pneumonia

“…Community-acquired pneumonia (CAP) is a cause of substantial and long-term mortality and morbidity, [1][2][3] and the number of patients admitted annually to hospital is increasing. [4][5][6] In recent years controversy has surrounded the prognostic benefit conferred by early antibiotic treatment of CAP on arrival to hospital.…”