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Risk factors for 30-day mortality in patients with pneumonia who receive appropriate initial antibiotics: an
Yuichiro Shindo1, Ryota Ito2, Daisuke Kobayashi3
1Institute for Advanced Research, Nagoya University, Nagoya, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Background:
Appropriate initial antibiotics are essential for the treatment of infectious diseases. However, some patients with pneumonia might develop adverse outcomes, despite receiving appropriate initial antibiotics. We aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotics and to identify potential candidates who would benefit from adjunctive therapy.
Methods:
From March 15, to Dec 22, 2010, we did a prospective, observational study at ten medical institutions in hospitalised patients (aged ≥20 years) with pneumonia. We did a multivariable logistic regression analysis to calculate odds ratios (ORs) and 95% CI to assess the risk factors for 30-day mortality. This study was registered with the University Medical Information Network in Japan, number UMIN000003306.
Findings:
The 30-day mortality was 11% (61 of 579 patients) in the appropriate initial antibiotic treatment group and 17% (29 of 168) in the inappropriate initial antibiotic treatment group. Albumin concentration of less than 30 mg/L (adjusted OR 3·39, 95% CI 1·83-6·28), non-ambulatory status (3·34, 1·84-6·05), pH of less than 7·35 (3·13, 1·52-6·42), respiration rate of at least 30 breaths per min (2·33, 1·28-4·24), and blood urea nitrogen of at least 7·14 mmol/L (2·20, 1·13-4·30) were independent risk factors in patients given appropriate initial antibiotic treatment. The 30-day mortality was 1% (one of 126 patients), 1% (two of 168), 17% (23 of 137), 22% (20 of 89), and 44% (14 of 32) for patients with no, one, two, three, and four or five risk factors, respectively.
Interpretation:
Patients with two or more risk factors were at a higher risk of death during the 30 days assessed than were individuals with no or one risk factor, despite appropriate initial antibiotic treatment. Therefore, adjunctive therapy might be important for improving outcomes in patients with two or more risk factors.
Funding:
Central Japan Lung Study Group.
Insights
Patients with pneumonia receiving appropriate antibiotics can still face high mortality. Identifying risk factors like low albumin and high respiratory rate is key for targeted adjunctive therapy to improve outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Pharmacology
Background:
- Appropriate initial antibiotic selection is crucial for treating infectious diseases like pneumonia.
- Despite appropriate treatment, some pneumonia patients experience adverse outcomes, necessitating further investigation into risk factors.
- Identifying patients at risk for mortality despite appropriate initial antibiotics is essential for optimizing treatment strategies.
Purpose of the Study:
- To identify independent risk factors for 30-day mortality in hospitalized pneumonia patients who received appropriate initial antibiotic therapy.
- To determine which patients with pneumonia, despite appropriate initial antibiotics, could benefit from adjunctive therapies.
Main Methods:
- A prospective, observational study was conducted across ten medical institutions involving hospitalized pneumonia patients aged 20 years and older.
- Multivariable logistic regression analysis was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with 30-day mortality.
- Data were collected from March 15 to December 22, 2010, and the study was registered with the University Medical Information Network in Japan (UMIN000003306).
Main Results:
- The 30-day mortality rate was 11% in the appropriate initial antibiotic group and 17% in the inappropriate group.
- Independent risk factors for 30-day mortality in patients receiving appropriate antibiotics included low albumin (<30 mg/L), non-ambulatory status, low pH (<7.35), high respiratory rate (≥30 breaths/min), and elevated blood urea nitrogen (≥7.14 mmol/L).
- Mortality risk significantly increased with the number of risk factors present, ranging from 1% for zero or one factor to 44% for four or five factors.
Conclusions:
- Patients with pneumonia and two or more identified risk factors face a substantially higher risk of 30-day mortality, even with appropriate initial antibiotic treatment.
- Adjunctive therapy should be considered for patients with pneumonia who present with two or more risk factors to potentially improve clinical outcomes.
- These findings highlight the importance of a comprehensive risk assessment beyond initial antibiotic appropriateness in managing pneumonia patients.