Prognosis and mortality effects of smoking in hopi̇tali̇zed pati̇ents wi̇th pneumoni̇a

Community acquired pneumonia (CAP) is leading cause in mortality related with infection. Studies that investigated the effect of smoking on development of CAP have been showed that smoking is risk factor in CAP and increase the CAP related mortality. In this study, we investigated the effect of smoking on prgnosis and mortality in patients with CAP by using the "Pneumonia Data Base".,ü 702 patients hospitalized due to CAP and registered to "Pneumonia Data Base" in Pulmonary Department of Celal Bayar University Faculty of Medicine, Akdeniz University Faculty of Medicine, Dokuz Eylul University Faculty of Medicine, and Ege University Faculty of Medicine between November 2009 and May 2013 were included to the study. "Pneumonia Data Base" that prepared by Turkish Thoracic Society Respiratory Infections Scientific Assembly included the datas about findings of patients at first day hospitalization, controls at hospitalization and discharged date, treatment results at first month and total treatment cost. There were 465 male (66,2%) and 237 female (33,8%) and mean age was 65 years. The percentage of never smoker, current smoker, and ex-smoker were 37,2%, 11%, and 51,7% respectively. The most seen symptoms were cough, sputum, fever, and fatigue. Sputum was mostly seen in ex-smokers whereas chest pain, headache and gastrointestinal system symptoms were mostly seen in current smokers. COPD, coronary artery disease and diabetes mellitus were found as mostly seen comorbidities. The percentage of COPD, coronary artery disease, and lung cancer were found significanltly high in ex-smokers. The percentage of inhaled corticosteroid usage, hospitalization in a previous 3 months, antibiotic usage in a previous 3 months, long term usage of systemic corticosteroid, and immunosuppresive usage in a previous 3 months were 22,5%, 15,4%, 19,7%, 7,1%, and 5,6% respectively. Percentage of immunization with influenza vaccine was 21,2% and 12,4% with PPV. Immunization with influenza an PPV vaccines were higher in ex-smokers. In chest radiography, percentage of consolidation, interstitial/patch involvement, cavitation, bilateral involvement, multilobar, and pleural effusion were 72,9%, 40,7%, 3,2%, 38,2%, 35%, and 20,7% respectively.There was no relation with chest radiography and smoking status. In current smokers, ALT and AST levels were found significantly higher and oxygen saturation were found lower. Mean CRP was 47,01±69,39 mg/mL and mean PCT was 7,64±24,23 mcg/l. There were no relation between smoking status and CRP and PCT. Pneumonia severity index was found significantly higher in ex-smokers whereas there was no relation between CURB-65 and smoking status. No relation was found between smoking status and hospitalization duration and treatment cost. According to treatment results, in 3-5 days, percentage of totally cured patients were high in active smokers and the percentage of partially cured patients were high in never smokers and ex-smokers. This result can be explained by the younger age and low percentage of comorbidty in active smokers. Mortality rate was found as 8,5%. Older age, presence of comorbidity, presence of smoking history were found related with mortality. As a result, we found that smoking affect many factors realted with CAP development and prognosis negatively and it increases the mortality in CAP with other factors like presence of comorbidity and older age.