Prognosis in community-acquired pneumonia requiring treatment in hospital. Importance of predisposing and complicating factors, and of diagnostic procedures.

Outcome and Prognostic Factors of Community-Acquired Pneumonia (CAP) (I-V): A pre-existing illness or alcoholism was present in 60% of 53 patients with CAP requiring treatment in an intensive care unit (ICU). An etiological diagnosis was established in only half of the patients, with S. pneumoniae as the predominating agent. Immediate active treatment was required in 70% of the patients, in 58% including mechanical ventilation. Mortality in hospital was 25% and rose to 39% after an average follow-up period of 3.25 years. A significantly higher mortality was seen in elderly patients, and in those who were immunocompromised, or had a leukocyte count less than or equal to 9 x 10(9)/l. In contrast to earlier discouraging data, and despite of the considerable case fatality rate, it was evident that many patients would not have survived without the intensive care treatment. In addition, the long-term prognosis was more favorable than previously reported. During an eight-year period, case fatality rate in bacteremic pneumococcal pneumonia (Pnb) was 7% (19/285) (99% confidence interval, 3-11%), in adult patients treated at either of the two departments for infectious diseases in Stockholm. In the last year of this period (1984), the mortality for all adults hospitalized because of Pnb in Stockholm county was 11% (7/62). The incidence of Pnb was 5/100,000/year, which is in accordance with earlier data, whereas the incidence of fatal Pnb was markedly lower than that reported from the U.S: 0.5 vs. about 1.5 per 100,000 per year. The reason for this low rate of early deaths in fulminant disease is not clear. No significant differences from earlier reports were found in pre-existing conditions, bacterial serotype distribution, duration of illness before hospitalization, or in frequency or sensitivity of blood cultures. As in earlier studies, we also found that male sex, alcoholism, absence of leukocytosis and extrapulmonary complications were significantly associated with a higher mortality. However, contrary to most other studies, high age was not a negative prognostic factor, perhaps like some other recent data indicating that the general health of elderly people in Sweden is remarkably good. Outcome, and prognostic factors were prospectively studied in 277 adults (mean age 62 years) hospitalized because of CAP. Despite the high age of many patients, only half had a pre-existing chronic disease. However, 58% had been treated in hospital at least once during the last five years.(ABSTRACT TRUNCATED AT 400 WORDS)