In-Hospital Deaths Among Adults With Community-Acquired Pneumonia.

Area of Science:

• Pulmonary Medicine
• Critical Care Medicine
• Geriatric Medicine

Background:

• Community-acquired pneumonia (CAP) poses a significant short-term mortality risk for hospitalized adults.
• The potential for improving in-hospital care to reduce this mortality risk remains unclear.
• This study investigated the causes and preventability of in-hospital deaths in a large CAP cohort.

Purpose of the Study:

• To determine the proportion of in-hospital deaths among adults with CAP that were potentially preventable.
• To identify factors contributing to mortality in hospitalized CAP patients.
• To assess the impact of in-hospital care quality on CAP-related deaths.

Main Methods:

• Adult patients hospitalized with CAP were enrolled across five U.S. tertiary-care hospitals.
• Physician investigators reviewed medical records and study data for all deceased patients.
• Causes of death, CAP's contribution, and potential preventability were assessed.

Main Results:

• Of 2,320 patients, 52 (2.2%) died during hospitalization.
• The majority of deceased patients were elderly (63.4% ≥ 65 years) and had multiple comorbidities (61.5%).
• Community-acquired pneumonia was the direct cause of death in 51.9% of cases; lapses in care potentially contributed to death in only 7.7% of patients.

Conclusions:

• In this tertiary-care hospital setting with low mortality, most in-hospital deaths from CAP were not preventable through enhanced in-hospital care.
• Factors such as end-of-life limitations, advanced age, and high comorbidity burden were prevalent among patients who died.
• The findings suggest that focusing on patient-specific factors and end-of-life care may be more impactful than solely improving general pneumonia care protocols.