Risk Factors for Mortality in Community-Acquired Pneumonia Patients Admitted to a Referral Hospital

Young Woo Lee; Jae Woo Jung; Song Ju Han; Eun Ju Jeon; Jae Cheol Choi; Jong Wook Shin; Jae Yeol Kim; In Won Park; Byoung Whui Choi

doi:10.4046/trd.2006.61.04.347

Journal List > Tuberc Respir Dis > v.61(4) > 1001010

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Lee, Jung, Ju Han, Jeon, Choi, Shin, Kim, Park, and Choi: Risk Factors for Mortality in Community-Acquired Pneumonia Patients Admitted to a Referral Hospital

Original Article

Tuberc Respir Dis 2006;61(4):347-355.

Published online: 19 October 2006

DOI: https://doi.org/10.4046/trd.2006.61.04.347

Risk Factors for Mortality in Community-Acquired Pneumonia Patients Admitted to a Referral Hospital

Young Woo Lee, M.D., Jae Woo Jung, M.D., Song Ju Han, M.D., Eun Ju Jeon, M.D., Jae Cheol Choi, M.D., Jong Wook Shin, M.D., Jae Yeol Kim, M.D., In Won Park, M.D., Byoung Whui Choi, M.D.

Department of Internal Medicine, Chung Ang University College of Medicine, Seoul, Korea

Address for correspondence: Byoung Whui Choi. M. D. Department of Internal Medicine, Chung-Ang University Hospital, 65-207, Hangangro-3ga, Youngsan-gu, 140-757 Seoul, Korea Phone: 02-748-9878 Fax: 748-9529 E-mail: bwchoimd@nownuri.net

Received 7 August 2006 Accepted 26 September 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Pneumonia is the most common cause of death among infectious diseases with community-acquired pneumonia being the sixth leading cause of death in the USA. In Korea, several studies have evaluated the prognosis of community-acquired pneumonia with a limited number of patients and risk factors. This study, evaluated all the possible risk factors (including the pneumonia severity index; PSI) in for the community-acquired pneumonia patients admitted to a referral hospital.

Methods:

The medical records of patients admitted to the Chung-Aug University Yongsan Hospital between January 2002 and January 2005 for community-acquired pneumonia were reviewed retrospectively. The demographic data, comorbidity, radiographic findings and laboratory results which might influence the prognosis of pneumonia were analyzed.

Results:

Among 179 patients admitted for community-acquired pneumonia, 29 patients died (mortality 16%). The risk factors for mortality in the comorbidity category were congestive heart failure and a myocardial infarction. The laboratory data, showed that albumin, LDH, total cholesterol, HDL, PT, aPTT, hemoglobin and blood urea nitrogen (BUN) were related to the prognosis. For the pneumonia severity index, the mortality rate increased in a step-wise manner from class I through class V.

Conclusions:

Comorbidities such as congestive heart failure and myocardial infarction as well as the albumin, LDH, total cholesterol, HDL cholestreol, prothrombin time, activated partial thrombotin time, hemoglobin and blood urea nitrogen(BUN) are important risk factors for mortality in patients with community-acquired pneumonia. PSI is a valuable index for evaluating the prognosis of community-acquired pneumonia.

Keywords: Community-acquired pneumonia, Risk factor, Mortality, PSI.

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Figure 1.

The number of patients in each class of PSI, the mortality rate increased step-wisely from class Ⅰ to class Ⅴ

Table 1.

Demographic data

	Survivor	Non-Survivor	p	ICU	Ward	p
Number	150	29	NS	24	155	NS
Age	69 (18~89)	69 (44~90)	0.001	69 (44-90)	69 (18-89)	0.001
M : F	95 : 55	12 : 12	NS	15 : 9	97 : 58	NS

p, p value; NS, statistically not significant; ICU : Intensive Care Unit; M, male; F, female

Table 2.

Underlying diseases

		Survival	Non-Survival	p	ICU	Ward	p
Present ca.	y	1 (1)	4 (14)	NS	2	3	NS
Present ca.	n	149 (99)	25 (86)	NS	22	152	NS
Previous ca.	y	4 (3)	7 (24)	NS	4	7	0.043
Previous ca.	n	146 (97)	22 (76)	NS	20	148	0.043
LC	y	2 (1)	1 (4)	NS	0	3	NS
LC	n	148 (99)	28 (96)	NS	23	152	NS
CHF	y	21 (14)	9 (31)	0.032	6	24	NS
CHF	n	129 (86)	20 (69)	0.032	18	131	NS
Cbr	y	5 (3)	1 (3)	NS	1	5	NS
Cbr	n	145 (97)	28 (97)	NS	23	150	NS
AMI	y	2 (1)	3 (10)	0.031	2	3	NS
AMI	n	148 (99)	26 (90)	0.031	22	152	NS
CRF	y	7 (5)	1 (4)	NS	1	7	NS
CRF	n	143 (95)	28 (96)	NS	23	148	NS
DM	y	32 (21)	9 (31)	NS	11	30	0.007
DM	n	118 (79)	20 (69)	NS	13	125	0.007
TDL	y	7 (5)	7 (24)	0.002	2	12	NS
TDL	n	143 (95)	22 (76)	0.002	22	143	NS

ICU, Intensive Care Unit; p, p value; NS, statistically not significant; Present ca., Present cancer; Previous ca., Previous cancer; LC, liver cirrhosis; CHF, congestive heart failure; Cbr, cerebral infarction; AMI, acute myocardial infarction; CRF, chronic renal failure; DM, diabetes mellitus; TDL, tuberculosis-destroyed lung

Table 3.

Vital signs at admission

	Survivor	Non-survivor	p	ICU	Ward	p
SBP (mmHg)	121.0±24.6	112.7±30.1	0.040	111.6±38.3	120.9±23.1	NS
DBP (mmHg)	75.2±14.7	67.9±20.0	0.036	65.8±25.2	75.0±13.6	NS
PR (/min)	94.1±18.9	106±28.6	0.005	113.2±34.8	93.5±17.0	0.012
RR (/min)	23.7±5.5	26.9±7.0	0.001	27±8.1	24±5.5	NS
BT (℃)	37.2±1.0	36.8±0.8	0.029	37.2±1.1	37.1±1	NS

CU, Intensive Care Unit; p, p value; SBP, systolic blood pressure; DBP, diastolic blood pressure; PR, pulse pressure; BT, body temperature

Table 4.

Differences in laboratory and radiographic findings between survivors and non-survivors of community-acquired pneumonia

	Survivor	Non-survivor	p	ICU	Ward	p
pH	7.442±0.698	7.409±0.133	NS	7.377±0.128	7.449±0.069	0.013
pCO₂ (mmHg)	35.7±10.9	32.7±9.1	NS	39.7±15.3	34.1±9.1	0.020
pO₂ (mmHg)	67.5±18.3	62.9±20.6	NS	54.8±15.2	69.3±18.6	<0.001
SaO₂ (%)	90.8±10.3	88.8±7.3	0.045	84.9±8.3	91.7±9.7	0.002
T.P. (g/dl)	6.2±0.7	5.8±1.1	NS	5.4±1.0	6.3±0.7	<0.001
Alb (g/dl)	3.5±0.5	2.8±0.7	<0.001	2.7±0.7	3.5±0.6	<0.001
Total ca. (mg/dl)	8.4±0.6	8.2±1.0	NS	7.9±1.1	8.5±0.6	0.008
LDH (IU/L)	406.7±159.7	597.2±401.3	0.012	579.7±235.9	416.0±219.9	0.001
TC (mg/dl)	145.2±41.8	129.7±52.7	0.043	122.7±44.4	145.8±43.3	0.019
HDL (mg/dl)	37.2±14.6	28.2±17.8	0.018	29.0±17.7	37.0±14.8	0.024
PT (%)	109.6±22.7	90.8±37,3	0.027	85.5±37.8	109.9±22.6	0.006
aPTT (sec)	35.6±7.1	43.7±17.5	0.015	45.5±16.2	35.6±7.8	0.009
Hgb (g/dl)	12.2±2.4	10.4±2.1	0.000	10.8±2.7	12.2±2.4	0.009
BUN (mg/dl)	19.0±13.5	31.6±26.1	0.000	37.1±25.3	18.7±13.7	0.002
Na+ (mEq/L)	136.0±4.9	133.6±5.6	NS	134.4±10.2	135.9±3.8	NS
PPE y	9 (6)	1 (4)	NS	2	8	NS
n	141(94)	28(96)	NS	22	147	NS

ICU, Intensive Care Unit; p, p value; NS, Statistically not significant; pCO₂, arterial pressure of CO₂; pO₂, arterial pressure of O₂; SaO₂, arterial saturation of O₂; T.P., total protein; Alb, albumin; LDH, lactate dehydrogenase; TC, total cholesterol; HDL, high-density lipoprotein; LDL, low-density lipoprotein; PT, prothrombin time; aPTT, activated partial thromboplastin time; Hgb, hemoglobin; BUN, blood urea nitrogen; PPE, parapneumonic effusion

Table 5.

Point Scoring System for Pneumonia Severity Index

Characteristic		Assigned Points
Demographic factor (Age)
Men		Age (yr)
Women		Age (yr) – 10
Nursing home resident		+ 10
Coexisting illness
Neoplastic disease		+ 30
Liver disease		+ 20
Congestive heart failure		+ 10
Cerebrovascular disease		+ 10
Renal disease		+ 10
Physical-examination findings
Altered mental status		+ 20
Respiratory rate ≥ 30/min		+ 20
Systolic blood pressure < 90 mmHg		+ 20
Temperature < 35℃ or ≥ 40℃		+ 15
Pulse ≥ 125/min		+ 10
Laboratory and radiographic
findings
Arterial pH < 7.35		+ 30
Blood urea nitrogen ≥ 30 mg/dL		+ 20
Sodium < 130 mmol/L		+ 20
Glucose ≥ 250 mg/dL		+ 10
Hematocrit < 30%		+ 10
Partial pressure of arterial oxygen		+ 10
< 60 mmHg
Pleural effusion		+ 10
Class	Points	Mortality
Ⅰ	<51	0.1%
Ⅱ	51-70	0.6%
Ⅲ	71-90	0.9%
Ⅳ	91-130	9.5%
Ⅴ	>130	26.7%

Reference : Fine MJ, et al. A prediction rule to identify low-risk patients with community acquired pneumonia NEJM 1997;336:243

Table 6.

Sputum culture

Bacteria	Survivor	Non-survivor	ICU	Ward
Streptococcus pneumoniae	13	3	6	10
Klebsiella pneumoniae	8	0	0	8
Acinetobacter baumannii	7	0	0	7
Haemophilus influenzae	5	0	0	5
Pseudomonas aeruginosa	3	1	0	4
Staphylococcus aureus	2	1	3	0

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