Health-related quality of life in community-acquired pneumonia: a prospective cohort study

Community-acquired pneumonia (CAP) is a leading cause of hospitalization and often results in impaired health-related quality of life (HRQoL). The prognostic value of HRQoL at admission and its recovery trajectory after CAP remain unclear. We investigated associations between HRQoL at admission and adverse outcomes, including ICU admission, rehospitalization, and mortality, and described changes in HRQoL 180 days post-discharge. In this prospective cohort study, 552 patients hospitalized with CAP completed the EQ-5D-5L questionnaire at admission; 262 patients were reassessed 180 days post-discharge. Patients were categorized into tertiles based on the EQ-5D utility index and dimension-specific scores. Associations between HRQoL and outcomes were analyzed using logistic and Cox regression models. The mean EQ-5D utility index at admission was 0.609 ± 0.266. Severe impairments were most common in usual activities (42%) and mobility (30%) dimensions. Lower HRQoL at admission (lowest vs. highest tertile) was associated with an increased risk of rehospitalization at 30 days (aHR 1.92, 95% CI: 1.18-3.13), 90 days (aHR 2.01, 95% CI: 1.33-3.03), and 180 days (aHR 1.82, 95% CI: 1.27-2.59) and an increased risk of mortality at 90 days (aHR 1.91, 95% CI 1.01-3.63) and 180 days (aHR 1.84, 95% CI 1.05-3.20). Severe impairment in the mobility dimension was associated with increased risks of ICU admission, rehospitalization within 30, 90, and 180 days, and mortality within 90 and 180 days, while severe impairment in the self-care dimension was associated with increased risks of rehospitalization within 30, 90, and 180 days and mortality within 180 days. Among survivors who completed the follow-up, HRQoL improved modestly over 180 days (+ 0.109 ± 0.247). Low HRQoL at admission, particularly impairments in the mobility and self-care dimensions, was associated with adverse outcomes in patients with CAP. HRQoL is an independent prognostic marker that may support clinical risk stratification in patients with CAP. The observed improvement in HRQoL over time should be interpreted cautiously as it reflects survivors who completed follow-up.Trial registration: ClinicalTrials.gov (NCT03795662).