Mwachari C W, Nduba V N, Park D R, Meier A S, Kariuki J N, Muyodi J A, Karimi F, Kigo A, Holmes K K, Cohen C R
Centre for Respiratory Disease Research, Kenya Medical Research Institute, PO Box 47855, Nairobi, Kenya.
Int J Tuberc Lung Dis. 2006 May;10(5):516-22.
Risk factors for mortality in hospitalized patients with community-acquired pneumonia (CAP) are well known. There are limited data on prognostic indicators among out-patients.
To compare the clinical presentation, outcome and prognostic factors for clinical improvement in human immunodeficiency virus (HIV) infected and non-HIV-infected out-patients with CAP.
Adults in Nairobi with CAP were treated with erythromycin as first-line therapy. Clinical symptoms were evaluated using a validated CAP-related symptom score (CSS). Clinical improvement was defined as reduction of baseline CSS by > or = 50%.
Of 531 adults enrolled with CAP, 422 (79.5%) completed follow-up. Participants had a mean age (+/- SD) of 33.7 +/- 11.4 years, 274 (51.6%) were male and 193 (37%) were HIV-seropositive with a higher baseline CSS (27 vs. 25, P < 0.006). Overall, 196 of 422 (46%) had clinical improvement by 28 days. Factors independently associated with a longer time to clinical improvement included not being married (adjusted hazard ratio [aHR] 0.66, 95% CI 0.48-0.92) and higher baseline CSS (aHR 1.05, 95% CI 1.03-1.06).
HIV-infected and non-infected patients with CAP responded similarly to out-patient treatment, but HIV-infected patients were more likely to present with severe symptoms. Baseline CSS and marital status were predictive of time to clinical improvement.
