| Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. | |
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MedLine Citation:
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PMID: 11996618 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: To our knowledge, no previous study has systematically examined pneumonia-related and pneumonia-unrelated mortality. This study was performed to identify the cause(s) of death and to compare the timing and risk factors associated with pneumonia-related and pneumonia-unrelated mortality. METHODS: For all deaths within 90 days of presentation, a synopsis of all events preceding death was independently reviewed by 2 members of a 5-member review panel (C.M.C., D.E.S., T.J.M., W.N.K., and M.J.F.). The underlying and immediate causes of death and whether pneumonia had a major, a minor, or no apparent role in the death were determined using consensus. Death was defined as pneumonia related if pneumonia was the underlying or immediate cause of death or played a major role in the cause of death. Competing-risk Cox proportional hazards regression models were used to identify baseline characteristics associated with mortality. RESULTS: Patients (944 outpatients and 1343 inpatients) with clinical and radiographic evidence of pneumonia were enrolled, and 208 (9%) died by 90 days. The most frequent immediate causes of death were respiratory failure (38%), cardiac conditions (13%), and infectious conditions (11%); the most frequent underlying causes of death were neurological conditions (29%), malignancies (24%), and cardiac conditions (14%). Mortality was pneumonia related in 110 (53%) of the 208 deaths. Pneumonia-related deaths were 7.7 times more likely to occur within 30 days of presentation compared with pneumonia-unrelated deaths. Factors independently associated with pneumonia-related mortality were hypothermia, altered mental status, elevated serum urea nitrogen level, chronic liver disease, leukopenia, and hypoxemia. Factors independently associated with pneumonia-unrelated mortality were dementia, immunosuppression, active cancer, systolic hypotension, male sex, and multilobar pulmonary infiltrates. Increasing age and evidence of aspiration were independent predictors of both types of mortality. CONCLUSIONS: For patients with community-acquired pneumonia, only half of all deaths are attributable to their acute illness. Differences in the timing of death and risk factors for mortality suggest that future studies of community-acquired pneumonia should differentiate all-cause and pneumonia-related mortality. |
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Authors:
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Eric M Mortensen; Christopher M Coley; Daniel E Singer; Thomas J Marrie; D Scott Obrosky; Wishwa N Kapoor; Michael J Fine |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Archives of internal medicine Volume: 162 ISSN: 0003-9926 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2002 May |
Date Detail:
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Created Date: 2002-05-08 Completed Date: 2002-05-31 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 1059-64 Citation Subset: AIM; IM |
Affiliation:
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Center for the Study of Health Disparities, VA Pittsburgh Healthcare Systems (Mail Stop 130-U), University Drive C, Location 11E127, Pittsburgh, PA 15240-1001, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cause of Death* Community-Acquired Infections / epidemiology Female Humans Male Outcome Assessment (Health Care) Pneumonia / epidemiology* Proportional Hazards Models Risk Factors Severity of Illness Index Socioeconomic Factors Time Factors |
| Grant Support | |
ID/Acronym/Agency:
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F32 HS00135/HS/AHRQ HHS; R01 HS06468/HS/AHRQ HHS |
| Comments/Corrections | |
Comment In:
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Arch Intern Med. 2002 Nov 25;162(21):2491-2; author reply 2492-3
[PMID:
12437413
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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