Increased Long-Term Mortality after an Episode of Community-Acquired Pneumonia--Time to Move beyond Descriptive Studies

In this issue of Clinical Infectious Diseases, Mortensen et al. [1] report the results of an analysis of factors associated with long-term mortality in patients who survived 90 days after presentation to the hospital with community-acquired pneumonia (CAP) [1]. The population studied was the cohort of patients enrolled in the Boston and Pittsburgh portion of the Patient Outcomes Research Team pneumonia project, which is a collaborative effort among investigators in Boston, Pittsburgh, and Hal-ifax, Nova Scotia, Canada [2]. Of the 1419 patients who were followed for a mean duration of 5.9 years, 608 (42.4%) died. A case-control method was used to determine whether there was increased long-term mortality among those who survived an episode of pneumonia. Control subjects were age-matched persons for whom data was obtained from US life tables. There was a significantly higher mortality among patients with CAP across all age groups than in the control population. In addition, the investigators analyzed the data to determine the factors that predicted long-term mortality. Sociodemo-graphic factors associated with mortality were age (stratified by decade), high school graduation level or less, male sex, and nursing home residence. In addition, comorbid conditions (as represented by the Charlson comorbidity score), pleural effusion, and steroid use were independently associated with long-term mortality. Do-not-resuscitate status at the time of presentation, poor nutritional status, and glucocorticoid use were also associated with increased mortality. Fever at the time of presentation was associated with decreased mortality. Long-term mortality following an episode of CAP has been the subject of a number of reports. Koivula et al. [3] examined the 12-year mortality among 122 older persons (у60 years of age) who survived pneumonia, compared with that among 4045 residents of a Finnish town who had not had an episode of pneumonia. Thirty-nine percent of the patients who survived CAP were alive at 10 years, compared with 61% of the patients who had not had CAP. Total mortality, cardio-vascular mortality, and pneumonia-associated mortality were all higher among the patients with CAP. Kaplan et al. [4] used an administrative database to examine the mortality among 158,960 Medicare recipients (у65 years of age) hospitalized with CAP, compared with that among 794,333 hospitalized control subjects. The in-hospital and 1-year mortality rates were 11% and 40%, respectively, for the patients with CAP and were 5.5% and 29.1%, respectively , for the control subjects. Advanced age and increasing number of comorbidities were major independent predictors of …