Pneumonia is the leading infectious cause of death in the US. Pneumonia is also thought to be a major life event in the elderly, signaling an early point in a downward spiral of debility. More aggressive treatment of severe community-acquired pneumonia (CAP) may therefore not result in improved long-term outcome even if in-hospital mortality is reduced.
Prospective observational study of patients admitted for CAP beginning in November 1998. Subsequent mortality was determined by direct patient contact, contact with close relative, or review of the Social Security Death Index. The Pneumonia Severity Index (PSI) was calculated on admission. Patients were included in the analysis if at least 1 year had passed since original admission for CAP.
404 subjects met analysis criteria. Mean age was 58.1 years (range 18-99), with 54.7% females and 60.1% African Americans. The overall long-term mortality rate was 38% at 1500 days after admission. Survival based on PSI category is seen in the Figure. No long-term mortality occurred in PSI class I patients while marked greater mortality rates occurred in PSI class V patients, even after hospital discharge. Acute and long-term mortality in PSI class II and III patients was virtually identical. PSI class IV patients had greater short-term mortality but subsequent mortality closely paralleled that of PSI class II and III patients.
The long-term mortality of community-acquired pneumonia varies by PSI score. The major difference between PSI class IV patients and PSI Class II/III patients is due to higher acute mortality rates with nearly identical subsequent mortality rates.
Although acute mortality of PSI class IV patients is clearly higher than PSI class II and III patients, the long-term mortality rate is similar. Efforts to improve inpatient mortality in this group should therefore result in equivalent improvement in long-term mortality.
R.G. Wunderink, None.