HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (32) Citing Articles via Google Scholar Google Scholar Articles by Marrie, T. J. Articles by Wu, L. Search for Related Content PubMed PubMed Citation Articles by Marrie, T. J. Articles by Wu, L.

Factors Influencing In-hospital Mortality in Community-Acquired Pneumonia^*

A Prospective Study of Patients Not Initially Admitted to the ICU

^* From the Department of Medicine, University of Alberta, Edmonton, AL, Canada.

Correspondence to: Thomas J. Marrie, MD, 2F1.30 Walter C. Mackenzie Health Sciences Center, 8840 112 St, Edmonton, AL T6G 2B7, Canada; e-mail: tom.marrie{at}ualberta.ca

Purpose: To determine the factors that predict in-hospital mortality among patients who require hospitalization for the treatment of community-acquired pneumonia (CAP).

Study design: Prospective observational study of all patients who were admitted to six hospitals in Edmonton, AL, Canada, with a diagnosis of CAP from November 15, 2000, to November 14, 2002. Pneumonia was defined as two or more respiratory symptoms and signs and an opacity on a chest radiograph as interpreted by the attending physician.

Results: A total of 3,043 patients were enrolled in the study, 246 of whom died (8.1%). On multivariate analysis, increasing pneumonia severity score, increasing age, site of care, consultation with a respirologist or infectious diseases physician, and functional status at the time of admission were all independently predictive of mortality. Increasing pneumonia severity risk score, increasing age, site of hospitalization, functional status, and consultation with an infectious diseases physician or a respirologist were independently associated with both early (< 5 days) and late ( 5 days) mortality. In contrast, partial or complete use of the pneumonia pathway was associated with decreased early mortality, but had no effect on late mortality. A low lymphocyte count and a high serum potassium level were associated with early but not with late mortality. The type of antibiotic therapy had an effect on late but not on early mortality.

Conclusions: Functional status at the time of hospital admission is a powerful predictor of mortality and should be incorporated into any scores or models that are used to predict mortality. While there are some common predictors of early and late in-hospital mortality, early mortality is not affected by the timing or type of antibiotic therapy, whereas late mortality is influenced by the type of antibiotic therapy. Hyperkalemia and lymphopenia are associated with early mortality.

Key Words: functional status • mortality • pneumonia

This article has been cited by other articles:

				S. R Majumdar, F. A McAlister, D. T Eurich, R. S Padwal, and T. J Marrie Statins and outcomes in patients admitted to hospital with community acquired pneumonia: population based prospective cohort study BMJ, November 11, 2006; 333(7576): 999 - 999. [Abstract] [Full Text] [PDF]