Maybe survivors of community-acquired pneumonia (CAP) should be treated like patients with other common high-risk chronic conditions, suggest researchers from the University of Alberta and Dalhousie University, both in Canada. In their study comparing 6,078 patients with CAP with 29,402 people without CAP, they found the legacy of CAP was a “tremendous burden” for the patient in the long term.
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Community-acquired pneumonia increased the risk of death in 10 years by > 50%. Over the study period, 2,858 patients (70 per 1,000 patient-years) with CAP died, vs 9,399 (40 per 1,000 patient-years) control subjects. Moreover, patients with CAP were hospitalized more often, had more emergency department visits, and had a nearly 4-fold absolute increase in subsequent CAP-related events. In fact, the analyses suggested that the survival curves for patients with CAP, compared with control subjects, continue to worsen and accelerate with time.
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Although older people had the highest absolute rates of CAP-associated morbidity and mortality, the very young (“surprisingly,” to the researchers) had the highest relative rates.
To their knowledge, the researchers say, theirs is the longest and largest outcomes study of patients with pneumonia reported to date. They note that, although outcomes have improved for patients with other common conditions, such as acute coronary syndrome and heart failure, no such significant improvements have been seen for patients with pneumonia.
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The reasons behind the poor prognosis aren’t fully known, the researchers say. They point to some research that has indicated pneumonia may alter underlying biologic processes, or it might be a manifestation of an underlying biologic process rather than the cause of death per se.
Eurich DT, Marrie TJ, Minhas-Sandhu JK, Majumdar SR. Am J Respir Crit Care Med. 2015;192(5):597-604.