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Jose M. Bordon, MD, PhD; Timothy Wiemken, MPH; Paula Peyrani, MD; Julio A. Ramirez, MD
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From the Department of Medicine (Dr Bordon), Section of Infectious Diseases, Providence Hospital and the Division of Infectious Diseases (Drs Wiemken, Peyrani, and Ramirez), University of Louisville Medical School.

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


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Ramirez participates in the speakers bureaus for Pfizer, Cubist, Astellas, and Ortho-McNeil. He also has received grants from Pfizer, Merck, Johnson and Johnson, and Cubist Pharmaceuticals. Drs Bordon, Wiemken, and Peyrani have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


© 2011 American College of Chest Physicians


Chest. 2011;139(2):474-475. doi:10.1378/chest.10-2494
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To the Editor:

Drs Rozzini and Trabucchi found a high mortality in elderly patients with the diagnosis of pneumonia similar to our recent study.1 Compared with our study, their data are from an elderly population (mean age 81.5 ± 7.6 and 79.7 ± 7.1 years) admitted to a geriatric center during the 36-month analysis. They reported a significantly higher 3-month mortality of patients with community-acquired pneumonia (CAP) (19.2%) vs patients without pneumonia (10.3%). The data presented by Drs Rozzini and Trabucchi add to the current evidence that pneumonia plays a role in the mortality of patients beyond the conventionally used 28-day final follow-up. In elderly patients with severe underlying conditions, an episode of CAP may be a marker of severe immunologic impairment. These patients are likely to die “with CAP.” On the other hand, in other elderly patients, CAP may reflect a transient breach in the normal respiratory immune mechanisms. In this scenario, the systemic inflammatory response due to CAP may accelerate the natural history of underlying conditions favoring poor outcomes. These patients are likely to die “due to CAP.” More research is needed to investigate the relation between CAP and long-term outcomes in elderly and very elderly patients hospitalized with CAP.

Bordon J, Wiemken T, Peyrani P, et al; and the CAPO Study Group and the CAPO Study Group Decrease in long-term survival for hospitalized patients with community-acquired pneumonia. Chest. 2010;1382:279-283. [CrossRef] [PubMed]
 

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Bordon J, Wiemken T, Peyrani P, et al; and the CAPO Study Group and the CAPO Study Group Decrease in long-term survival for hospitalized patients with community-acquired pneumonia. Chest. 2010;1382:279-283. [CrossRef] [PubMed]
 
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