Long-term survival after hospitalization for community-acquired and healthcare-associated pneumonia

Abstract

Background: Elderly patients surviving community-acquired pneumonia (CAP) have subsequent increased mortality. However, little is known regarding long-term survival in younger adults or those with healthcare-associated pneumonia (HCAP).

Objectives: To identify factors associated with mortality and compare long-term survival in patients hospitalized with HCAP to that of patients with CAP.

Methods: We determined survival after discharge as of December 2002 in a patient cohort admitted with pneumonia between June 1994 and May 1996. We used the Cox proportional hazard model to estimate differences in survival after controlling for confounders.

Results: Of the 522 patients hospitalized with pneumonia, 457 survived to discharge. One hundred sixty-four patients (36%, 95% confidence interval, CI, 31-40%) were admitted with HCAP, while 293 (64%, 95% CI 60-69%) were admitted with CAP. Of the 181 deaths in the follow-up period, 70 occurred in patients under age 65 years admitted with HCAP (53% death rate, 95% CI 44-62%). Nineteen of these deaths (27%, 95% CI 17-39%) occurred in the absence of HIV infection. In patients under the age of 65 whose only risk factor for HCAP was treatment for pneumonia or hospitalization in the previous 90 days, 4 of 13 patients (31%, 95% CI 9-61%) died. Twenty percent (95% CI 15-26%) of patients under age 65 years admitted with CAP died during the follow-up.

Conclusions: Admission for HCAP, and to a lesser degree CAP, is associated with increased long-term mortality even in young patients. Future studies are warranted to identify interventions to improve survival in this population.