Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus of TU Dresden, Fetscherstr. 74, Dresden, 01307, Germany.
Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany.
Eur J Clin Microbiol Infect Dis. 2022 Apr;41(4):621-630. doi: 10.1007/s10096-022-04416-5. Epub 2022 Feb 8.
There are few data on mortality after discharge with community-acquired pneumonia (CAP). Therefore, we evaluated risk factors for 30-day post-discharge mortality after CAP. We included all patients of the prospective multi-national CAPNETZ study between 2002 and 2018 with (1) hospitalized CAP, (2) survival until discharge, and (3) complete follow-up data. The study endpoint was death within 30 days after discharge. We evaluated risk factors including demographics, comorbidities, admission CAP severity, and laboratory values and treatment-related factors in uni- and multivariable analyses. A total of 126 (1.6%) of 7882 included patients died until day 30 after discharge, corresponding to 26% of all 476 deaths. After multivariable analysis, we identified 10 independent risk factors: higher age, lower BMI, presence of diabetes mellitus, chronic renal or chronic neurological disease (other than cerebrovascular diseases), low body temperature or higher thrombocytes on admission, extended length of hospitalization, oxygen therapy during hospitalization, and post-obstructive pneumonia. By addition these factors, we calculated a risk score with an AUC of 0.831 (95%CI 0.822-0.839, p < 0.001) for prediction of post-discharge mortality. Early post-discharge deaths account for ¼ of all CAP-associated deaths and are associated with patient- and CAP-severity-related risk factors. Additional studies are necessary to replicate our findings in independent cohorts. Study registration: NCT02139163.
关于社区获得性肺炎（CAP）出院后死亡率的数据很少。因此，我们评估了 CAP 出院后 30 天内死亡的危险因素。我们纳入了 2002 年至 2018 年期间前瞻性多国 CAPNETZ 研究中的所有患者，这些患者符合以下条件：（1）住院 CAP；（2）存活至出院；（3）具有完整的随访数据。研究终点为出院后 30 天内死亡。我们评估了单变量和多变量分析中的危险因素，包括人口统计学、合并症、入院时 CAP 严重程度、实验室值和治疗相关因素。在 7882 例纳入患者中，共有 126 例（1.6%）在出院后 30 天内死亡，占所有 476 例死亡的 26%。多变量分析后，我们确定了 10 个独立的危险因素：年龄较大、BMI 较低、患有糖尿病、慢性肾脏或慢性神经疾病（除脑血管疾病外）、入院时体温较低或血小板较高、住院时间延长、住院期间氧疗以及阻塞性肺炎后。通过增加这些因素，我们计算了一个风险评分，其 AUC 为 0.831（95%CI 0.822-0.839，p<0.001），用于预测出院后死亡率。出院后早期死亡占所有 CAP 相关死亡的四分之一，与患者和 CAP 严重程度相关的危险因素有关。需要进一步的研究来在独立队列中复制我们的发现。研究注册：NCT02139163。
