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Original Research: Chest Infections |

Tobacco Smoking Increases the Risk for Death From Pneumococcal PneumoniaSmoking Worsens Pneumococcal Pneumonia Outcomes

Salvador Bello, MD; Rosario Menéndez, MD; Antoni Torres, MD, FCCP; Soledad Reyes, MD; Rafael Zalacain, MD; Alberto Capelastegui, MD; Javier Aspa, MD; Luis Borderías, MD; Juan J. Martin-Villasclaras, MD; Immaculada Alfageme, MD; Felipe Rodríguez de Castro, MD; Jordi Rello, MD; Luis Molinos, MD; Juan Ruiz-Manzano, MD
Author and Funding Information

From the Servicio de Neumología (Dr Bello), Hospital Universitario Miguel Servet, Zaragoza; Servicio de Neumología (Drs Menéndez and Reyes), IIS Hospital Universitario la Fe, Valencia; Servei de Pneumologia (Dr Torres), Institut Clinic del Torax, Universitat de Barcelona, Ciberes GRS, Barcelona; Servicio de Neumología (Dr Zalacain), Hospital de Cruces, Bilbao; Servicio de Neumología (Dr Capelastegui), Hospital de Galdakao, Galdakao; Servicio de Neumología (Dr Aspa), Hospital de la Princesa Spain, Madrid; Servicio de Neumología (Dr Borderías), Hospital San Jorge, Huesca; Servicio de Neumología (Dr Martin-Villasclaras), Hospital Carlos Haya, Málaga; Servicio de Neumología (Dr Alfageme), Hospital de Valme, Sevilla; Servicio de Neumología (Dr Rodríguez de Castro), Hospital Dr Negrín, Las Palmas de Gran Canaria; Critical Care (Dr Rello), Hospital Vall d’Hebron, Institut de Recerca Vall d’Hebron-UAB, CIBERES, Barcelona; Servicio de Neumología (Dr Molinos), Hospital Central de Asturias, Oviedo; and Servicio de Neumología (Dr Ruiz-Manzano), Hospital Germans Trias i Pujol, Badalona, Spain.

CORRESPONDENCE TO: Salvador Bello, MD, Servicio de Neumología, Hospital Universitario Miguel Servet, Isabel La Católica, 1-3. 50009, Zaragoza, Spain; e-mail: sbello@salud.aragon.es


FUNDING/SUPPORT: This study was supported by the Centro de investigación en red de enfermedades respiratorias, an initiative of the Instituto de Salud Carlos III [Fis Grant PI 041150]; Sociedad Española de Neumología y Cirugía torácica (SEPAR) and PII (SEPAR Research Programme) in respiratory infections [Grant 2007]; and a grant from the Ministry of Health of the Autonomous Community of Valencia [2007/0059].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):1029-1037. doi:10.1378/chest.13-2853
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BACKGROUND:  Active smoking increases the risk of developing community-acquired pneumonia (CAP) and invasive pneumococcal disease, although its impact on mortality in pneumococcal CAP outcomes remains unclear. The aim of this study was to investigate the influence of current smoking status on pneumococcal CAP mortality.

METHODS:  We performed a multicenter, prospective, observational cohort study in 4,288 hospitalized patients with CAP. The study group consisted of 892 patients with pneumococcal CAP: 204 current smokers (22.8%), 387 nonsmokers (43.4%), and 301 exsmokers (33.7%).

RESULTS:  Mortality at 30 days was 3.9%: 4.9% in current smokers vs 4.3% in nonsmokers and 2.6% in exsmokers. Current smokers with CAP were younger (51 years vs 74 years), with more alcohol abuse and fewer cardiac, renal, and asthma diseases. Current smokers had lower CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) scores, although 40% had severe sepsis at diagnosis. Current smoking was an independent risk factor (OR, 5.0; 95% CI, 1.8-13.5; P = .001) for 30-day mortality of pneumococcal CAP after adjusting for age (OR, 1.06; P = .001), liver disease (OR, 4.5), sepsis (OR, 2.3), antibiotic adherence to guidelines, and first antibiotic dose given < 6 h. The independent risk effect of current smokers remained when compared only with nonsmokers (OR, 4.0; 95% CI, 1.3-12.6; P = .015) or to exsmokers (OR, 3.9; 95% CI, 1.09-4.95; P = .02).

CONCLUSIONS:  Current smokers with pneumococcal CAP often develop severe sepsis and require hospitalization at a younger age, despite fewer comorbid conditions. Smoking increases the risk of 30-day mortality independently of tobacco-related comorbidity, age, and comorbid conditions. Current smokers should be actively targeted for preventive strategies.


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