Risk factors for adverse outcome in persons with pneumococcal pneumonia

To identify risk factors for death and respiratory failure in persons with penicillin-sensitive pneumococcal bacteremia and pneumonia from data available at initial clinical evaluation.

Retrospective chart review of persons with pneumococcal bacteremia and pneumonia.

Tertiary care medical center (University of California Davis Medical Center, Sacramento).

One hundred two consecutive adults admitted to the hospital for treatment of pneumococcal pneumonia with bacteremia.

Of 102 persons, 25 (25%; 95% confidence interval [CI], 17 to 34%) died and 17 (16%; 95% CI, 10 to 25%) survived mechanical ventilation for respiratory failure. In univariate analyses, persons with preexisting lung disease (relative risk [RR], 2.0; 95% CI, 1.3 to 3.1), initial body temperature < 38 degrees C (RR, 2.1; 95% CI, 1.3 to 3.6), or nosocomial infections (RR, 2.5; 95% CI, 1.8 to 3.6) or who were > or = 48 years old (RR, 2.7; 95% CI, 1.5 to 4.8) were at greater risk for adverse outcomes than persons without these risk factors. Of 25 persons without these risk factors, only one (4%; 95% CI, 0 to 20%) died, and the remaining 24 persons did not require intensive care. Using these risk factors in a multivariate logistic model, death or respiratory failure would have been predicted in 67% of persons and better outcome predicted in 83% of the persons. In multivariate analysis, nosocomial infection was the greatest risk factor (adjusted odds ratio, 17.3; 95% CI, 3.1 to 98).

Risk factors identified at hospital admission can predict the outcome in persons with pneumococcal pneumonia and bacteremia. Identifying these factors may allow earlier use of intensive care or more aggressive treatment. Independent of age, nosocomially acquired infections were the greatest risk factor for death or respiratory failure.