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Original Research: PNEUMONIA |

Decrease in Long-term Survival for Hospitalized Patients With Community-Acquired Pneumonia

Jose Bordon, MD, PhD; Timothy Wiemken, MPH; Paula Peyrani, MD; Maria Luz Paz, MD; Martin Gnoni, MD; Patricio Cabral, MD; Maria del Carmen Venero, MD; Julio Ramirez, MD; the CAPO Study Group
Author and Funding Information

From the Division of Infectious Diseases (Drs Bordon, Peyrani, Paz, Gnoni, Cabral, Venero, and Ramirez and Mr Wiemken), University of Louisville Medical School, Louisville, KY; and the Section of Infectious Diseases, Department of Medicine (Dr Bordon), Providence Hospital, Washington, DC.

Correspondence to: Jose M. Bordon, MD, PhD, Providence Hospital, Department of Medicine, Section of Infectious Diseases 1150 Varnum St, Washington, DC 20017; e-mail: jbordon@provhosp.org


For editorial comment see page 248

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(2):279-283. doi:10.1378/chest.09-2702
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Background:  The association of hospitalization because of community-acquired pneumonia (CAP) and long-term survival has not been fully examined. We measured the long-term survival of hospitalized patients with CAP adjusted for the effects of comorbidities.

Methods:  A cohort of adult patients admitted to the medical services of the Veterans Affairs Medical Center, Louisville, Kentucky, was retrospectively examined. A Kaplan-Meier survival curve was constructed to assess the effect of CAP admission status on patient survival. A Cox proportional hazards regression model included comorbidities as predictors and time to death as the outcome in the construction of a modified Charlson Comorbidity Index (mCCI). The mCCI was internally validated to evaluate the predictability of patient survival. The mCCI and age > 65 years were included as potential confounders in a final Cox proportional hazards regression model with CAP admission status as the main predictor and time to death as the outcome.

Results:  CAP was identified in 624 (9%) out of 6,971 patients. The Kaplan-Meier survival curve showed a significantly shorter survival among patients with CAP than those without CAP (P < .0001). The internal validation of the mCCI showed that patients were more likely to die as the mCCI increased (P < .0001). The Cox proportional hazards regression modeling the association between time to death and CAP admission after adjusting for elderly age and the mCCI showed that hospitalization due to CAP was a statistically significant predictor of decreased survival (hazard ratio, 1.4; 95% CI, 1.2-1.5; P < .0001).

Conclusion:  There is a decreased long-term survival among hospitalized patients with CAP after adjusting for comorbidities and aging. Future research to understand the pathophysiology of the long-term CAP outcomes is necessary to develop treatment strategies.

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