The impact of pneumonia on death usually occurs in the first year after the acute illness. However, the prognostic implication of an episode of community-acquired pneumonia (CAP) continues for at least 5 years after the initial illness, according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award fellowship F32 HS00135). About one-third of CAP patients who survived 90 days after hospitalization for CAP died within 6 years. Patient characteristics—especially age, coexisting medical conditions, and nursing home residence—were the strongest independent predictors of long-term mortality.
After adjustment for these factors, abnormal acute physiologic or laboratory findings, which generally predict short-term CAP death, did not predict long-term death. Long-term mortality appears to be associated with intrinsic characteristics of the patient, which for the most part are not modifiable by medical care. Many chronic illnesses that predispose patients to development of CAP—including chronic cardiopulmonary disease, cancer, and neurologic disease—also contribute to its long-term mortality, explains lead author Eric M. Mortensen, M.D., M.Sc., of the University of Pittsburgh. He advises that clinicians keep these results in mind, when discussing long-term prognosis with CAP patients and their families.
Dr. Mortensen and his colleagues compared the mortality of patients with pneumonia enrolled at four sites who survived at least 90 days after arriving at the hospital with mortality among age-matched control subjects (for whom data were derived from U.S. life tables). Of the 1,555 patients studied, 9 percent died within 3 months of hospitalization, and 30 percent died during the nearly 6-year study period.
See "Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia," by Dr. Mortensen, Wishwa N. Kapoor, M.D., M.P.H., Chung-Chou Chang, Ph.D., and Michael J. Fine, M.D., M.S.C., in the December 15, 2003, Clinical Infectious Diseases 37, pp. 1617-1624.
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