Intra-hospital mortality for community-acquired pneumonia in mainland Portugal between 2000 and 2009

Teixeira-Lopes, Francisca; Cysneiros, Ana; Dias, Ana; Durão, Vera; Costa, Cláudia; Paula, Fernanda de; Serrado, Margarida; Nunes, Baltazar; Diniz, António; Froes, Filipe

doi:10.1016/j.pulmoe.2018.06.004

Cited by 15 publications

(12 citation statements)

References 15 publications

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“…Hospital mortality in our main cohort was 12.4%, which is higher than in many previous clinical studies [1,14] but comparable to that in other recent European population-based cohorts [15,16]. It is reasonable to assume that these differences result from exclusion of many high-risk patients in clinical trials.…”

Section: Discussionsupporting

confidence: 68%

Validation of the qSOFA score compared to the CRB-65 score for risk prediction in community-acquired pneumonia

Kesselmeier

Pletz

Blankenstein

et al. 2021

Clinical Microbiology and Infection

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Objective: The qSOFA (quick sepsis-related organ failure assessment) score shows similarities to the CRB-65 pneumonia score, but its prognostic accuracy in patients with community-acquired pneumonia (CAP) has not been extensively evaluated. Our aim was to validate the qSOFA (-65) score in a large cohort of CAP patients. Methods: We conducted a retrospective population-based cohort study including all CAP cases hospitalized between 1st January 2014 and 31st December 2018 from the German nationwide mandatory quality assurance programme. We excluded cases transferred from another hospital, with mechanical ventilation present on admission, and without documented respiratory rate. Predefined outcomes were hospital mortality and need for mechanical ventilation. Results: Among the 1,262,250 included cases, hospital mortality was 12.4% and the mechanical ventilation rate was 7.1%. All CRB and qSOFA criteria were associated with both outcomes, but the qSOFA had inferior sensitivity compared to the CRB-65 for mortality prediction. Including the age criterion 65 years, qSOFA-65 and CRB-65 performed similarly (AUC 0.69, 95%CI 0.69e0.69 versus 0.68, 95%CI 0.68e0.68). A qSOFA-65 of 0 was associated with fewer missed deaths (3328, 2.0%) compared to a CRB-65 of 0 (5480, 2.4%). The sensitivity of the suggested qSOFA cut-off of 2 for sepsis was low (mortality 25.8%, 95%CI 25.6e26.0%; mechanical ventilation 24.1%, 95%CI 23.8e24.4%). Results were similar when frail and palliative patients were excluded. Conclusions: The qSOFA parameters show prognostic accuracy similar to the CRB parameters in CAP, but the sepsis cut-off of 2 lacked sensitivity. For sensitive mortality prediction, the age criterion 65 years should be added to the qSOFA.

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Section: Discussionsupporting

confidence: 68%

Validation of the qSOFA score compared to the CRB-65 score for risk prediction in community-acquired pneumonia

Kesselmeier

Pletz

Blankenstein

et al. 2021

Clinical Microbiology and Infection

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“…[ 36 ]. The mortality rate obtained in our study (20.82% of mortality considering the HCAP classification) is similar to previous studies on CAP mortality (20.4%, 2000–2009) [ 17 ] and total pneumonia (20.3%, 2018) in Portugal [ 4 ] but significantly lower when compared to the data reported in 2015 (57.7%) [ 3 ]. Some factors that occurred in the last years in Portugal may have helped reduce this rate.…”

Section: Discussionsupporting

confidence: 89%

“…In Portugal, the epidemiological and clinical evidence available is focused on community-acquired pneumonia (CAP) [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] at global and regional level in mainland Portugal [ 18 ], on CAP and influenza hospitalizations [ 11 , 19 ] and, recently on organizing pneumonia due to COVID-19 [ 20 , 21 , 22 ]. No studies have focused specifically on HCAP.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological Characterization and the Impact of Healthcare-Associated Pneumonia in Patients Admitted in a Northern Portuguese Hospital

Méndez

Castro

Ferreira

et al. 2021

JCM

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Pneumonia is one of the main causes of hospitalization and mortality. It’s the fourth leading cause of death worldwide. Healthcare-associated infections are the most frequent complication of healthcare and affect hundreds of millions of patients around the world, although the actual number of patients affected is unknown due to the difficulty of reliable data. The main goal of this manuscript is to describe the epidemiological characteristics of patients admitted with pneumonia and the impact of healthcare-associated pneumonia (HCAP) in those patients. It is a quantitative descriptive study with retrospective analysis of the clinical processes of 2436 individuals for 1 year (2018) with the diagnosis of pneumonia. The individuals with ≤5 years old represented 10.4% (n = 253) and ≥65 were 72.6% (n = 1769). 369 cases resulted in death, which gives a sample lethality rate of 15.2%. The severity and mortality index were not sensitive to the death event. We found 30.2% (n = 735) individuals with HCAP and 0.41% (n = 59) with ventilator-associated pneumonia (VAP). In only 59 individuals (2.4%) the agent causing pneumonia was isolated. The high fatality rate obtained shows that pneumonia is a major cause of death in vulnerable populations. Moreover, HCAP is one of the main causes of hospital admissions from pneumonia and death and the most pneumonias are treated empirically. Knowledge of the epidemiology characterization of pneumonia, especially associated with healthcare, is essential to increase the skills of health professionals for the prevention and efficient treatment of pneumonia.

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“…Indeed, Portugal stands out from the rest of the EU countries, as it is one of the fastest ageing countries, considering that by 2050 those aged 55 and over should represent almost half (47.1%) of the total population [32]. In addition, Teixeira-Lopes hypothesized that the fear of dying at home, of patients and family members, could explain the inclusion of many patients with end-of-life pneumonia, especially in older age groups, and we believe this may have impact on observed hospital mortality [33].…”

Section: Discussionmentioning

confidence: 87%

Factors associated with in-hospital mortality from community-acquired pneumonia in Portugal: 2000–2014

et al. 2020

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Background: Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide, often leading to hospital admissions. In Portugal, the factors associated with in-hospital mortality due to CAP are not fully documented. The aim of this study was to characterize the trends of CAP hospitalization in all age groups and the factors associated with their mortality between 2000 and 2014. Methods: We conducted a cross-sectional study using CAP hospitalization data in all age groups, in Portugal Mainland. Logistic regression was used to identify the factors associated with in-hospital mortality. Results: Between 2001 and 2011, CAP hospitalization rate increased from 2.8 to 4.3 per 1000 population. Hospitalization rates were higher in the extreme ages (≤ 4 and ≥ 75 years). However, a decrease in the hospitalization rate and its mortality was observed, in the younger ages. A total of 548,699 hospitalization CAP episodes, between 2000 and 2014, were analyzed, with male (56.2%) and elderly ≥65 years (91.7%) predominance, resulting in 101,740 deaths (18.5%). Men had a significantly lower mean age (64.3 ± 26.4 years versus 67.9 ± 27.5 years; p < 0.001). During the studied 15 years, there was an increase of 45.2% in the number of annual hospitalizations, concomitant with the admission increase of individuals aged over 75 years. Since 2012 a decrease in hospitalizations and associated deaths were detected. The increase in age represented a progressive and significant rise in the probability of death, except for the age group 1-4 years. The age group ≥85 years old (Adjusted OR = 124.256; 95%CI: 97.838-157.807) and males (Adjusted OR = 1.261; 95%CI: 1.243-1.280) were significantly associated with death risk for CAP hospitalization. After 2010, this risk decreased (Adjusted OR = 0.961; 95%CI: 0.940-0.982). The main factors affecting mortality were age, sex, unemployment rate, number of performed procedures and admission quinquennia. Conclusions: Despite a trend of decrease in CAP hospitalizations and associated death since 2012, the numbers of in-hospital mortality showed, in the 15 years under analysis, an overall increase over time, mainly associated with age, in particular very old people (≥ 75 years), males and a higher parish unemployment rate. Therefore, the implementation of CAP preventive measures should be reinforced in these vulnerable groups.

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Intra-hospital mortality for community-acquired pneumonia in mainland Portugal between 2000 and 2009

Abstract: CAP remains an important cause of hospital mortality in all age groups.

Cited by 15 publications

References 15 publications

Validation of the qSOFA score compared to the CRB-65 score for risk prediction in community-acquired pneumonia

Validation of the qSOFA score compared to the CRB-65 score for risk prediction in community-acquired pneumonia

Epidemiological Characterization and the Impact of Healthcare-Associated Pneumonia in Patients Admitted in a Northern Portuguese Hospital

Factors associated with in-hospital mortality from community-acquired pneumonia in Portugal: 2000–2014

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