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Long-term Symptom Recovery and Health-Related Quality of Life in Patients With Mild-to-Moderate-Severe Community-Acquired Pneumonia^*

^* From the Department of Internal Medicine (Drs. el Moussaoui, Speelman, and Prins), Division of Infectious Diseases, Tropical Medicine, and AIDS, and the Departments of Clinical Epidemiology and Biostatistics (Drs. Opmeer, de Borgie, and Bossuyt), and Medical Psychology (Dr. Nieuwkerk), Academic Medical Center, Amsterdam, the Netherlands. A complete list of participants and contributors to the Duration Antibiotic Therapy Evaluation Study-pneumonia study is located in the ^Appendix.

Correspondence to: Rachida el Moussaoui, MD, Academic Medical Center, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Room F4-217, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; e-mail: r.elmoussaoui{at}amc.uva.nl

Abstract

Study objectives: The long-term outcomes of patients with community-acquired pneumonia (CAP) in terms of symptom resolution and health-related quality of life (HRQL) is unknown. Our objective was to determine the rate of symptom resolution using validated patient-based outcome measures, and to assess HRQL 18 months after the episode.

Participants: Patients were recruited from a group enrolled in a randomized trial comparing two durations of treatment for CAP. Between 2000 and 2003, we included 102 adults with a mild-to-moderate-severe CAP (pneumonia severity index, 110).

Interventions: CAP-related symptoms were assessed until month 18 using the CAP score. The CAP score was divided into respiratory and well-being sections to assess the recovery of respiratory and well-being symptoms separately. The HRQL was assessed at 18 months using the Medical Outcomes Study 36-item short form (SF-36) questionnaire and compared to a Dutch reference group.

Results: Respiratory symptoms resolved within 14 days, while the well-being symptoms resolved more slowly. Taking the prepneumonia status into account, patients recovered fully from pneumonia after 6 months. Patients with comorbid conditions had significantly more symptoms prepneumonia and during follow-up than patients without comorbidities, but at all time points the proportion of patients that reached 80% of the prepneumonia health level did not depend on comorbidity, age, or etiology. SF-36 scores at 18 months were significantly impaired in four of the eight dimensions for patients with comorbid illness, but did not differ from the reference population for patients without comorbid illness.

Conclusion: Patients with mild-to-moderate-severe CAP recover fully from pneumonia after 6 months. The presence of symptoms beyond 28 days and any impairment in HRQL were found to reflect age and comorbidity rather than the persistent effects of the pneumonia itself.

Key Words: community-acquired pneumonia • Medical Outcomes Study 36-item short form questionnaire • symptom resolution • validated patient-based outcome measures