Community-Acquired Pneumonia: Risk Factors for Mortality 30 Days Post Discharge

Community-acquired pneumonia (CAP) mortality within 30 days after hospital discharge account for one-fourth of all CAP associated deaths and are associated with patient and CAP severity-related risk factors, according to findings published recently in the European Journal of Clinical Microbiology & Infectious Diseases.

Early post-discharge CAP-related complications could potentially be mitigated with specific interventions if contributing factors could be identified; however, data on mortality after discharge for CAP is difficult to come by. To evaluate the risk factors for 30-day post-discharge mortality after CAP, researchers conducted a univariable and multivariable cohort study that included 7882 adult patients from the multi-national prospective CAPNETZ study (ClinicalTrials.gov Identifier: NCT02139163), which prospectively collected data on patients with CAP in more than 40 local European clinical centers. Patients in the current study were from the CAPNETZ cohort between 2002 and 2018, hospitalized with CAP, survived until discharge, and had complete follow-up data until at least 30 days after discharge. Current study participants were all diagnosed via chest imaging and had at least 1 of the following: history of fever, cough, production of purulent sputum, or focal chest signs on auscultation. Death within 30 days after discharge was the study primary endpoint.

Risk factor evaluation included demographics, comorbidities, admission CAP severity, and laboratory values and treatment-related factors. Before discharge, 350 patients with CAP died; within the 30-day discharge window, an additional 126 patients died (26% of all 476 deaths).

The study analysis identified 10 independent risk factors: higher age, lower BMI, presence of diabetes mellitus, chronic renal or chronic neurological disease (other than cerebrovascular diseases), low body temperature or higher thrombocytes on admission, extended length of hospitalization, oxygen therapy during hospitalization, and post-obstructive pneumonia.

A risk score for prediction of post-discharge mortality was calculated with an area under the curve of 0.831 (95%CI 0.822–0.839, P <.001). Researchers noted their early post-discharge mortality rate of 1.6% was low compared to other recent studies, noting that this might be due to CAPNETZ selection bias towards younger and healthier patients.

Researchers concluded that early post-discharge deaths in the CAPNETZ study cohort accounted for 26% of all deaths until 30 days after discharge, and that early post-discharge mortality was associated with 10 patient- and CAP-related risk factors. The investigators added that “intensifed post-discharge follow-up with close monitoring of preexisting comorbidities and CAP complications might be considered especially in elderly, multimorbid patients and those with severe CAP after hospital discharge.”

This study was limited by the use of data exclusively from the prospectively recruited CAPNETZ study cohort, as well as by the absence of some follow-up data, the unavailability of hospital data before discharge, the unavailability of clinical stability criteria for hospital discharge, and the lack of data on causes of death.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Glöckner V, Pletz MW, Rohde G, et al. Early post-discharge mortality in CAP: frequency, risk factors and a prediction tool. Eur J Clin Microbiol Infect Dis. Published online February 8, 2022. doi:10.1007/s10096-022-04416-5