Factors affecting mortality in community-developed and hospitalized pneumonia patients

ABSTRACT Aim: The aim of the study is to evaluate the factors that affect mortality among patients who require hospitalization for the treatment of community-acquired pneumonia Study Design: The study has been conducted in Ministery of Health Recep Tayyip Erdoğan Training and Research Hospital Department of Chest Disease. 78 patients were enrolled in the study 53 of whom were men and 25 of whom were women and who were admitted to polyclinics of chest disease and emergency department and require hospitalization for the treatment between January 2012 and January 2015. Patient demographic profile (age, sex, smoking habits), other diseases they have, vaccination status for pneumococca and influenza, admission to intensive care unit during the hospitalization, the use of invasive mechanical ventilation treatment, length of hospital stay and mortality information were recorded. Respiratory rate , blood pressure, body temperature, pulse, state of consciousness, oxygen saturation via pulse oximetry were measured during the hospital admission as physics examination findings. Values of pO2, pCO2, % Sat O2, pH were measured using arterial blood gas analysis. Hemogram, coagulation, D-dimer, CRP, sedimentation, fibrinogen and biochemistery parameters were measured on admission and 1. and 4. days. CURB-65 and PSI scores were also taken into account. Results: A total of 78 patients were enrolled in the study. The mean of the ages of the patients was 74±16. Out of the 78 patients, 53 patients (68%) were men and 25 patients (32%) were women. Among the 78 patients, 30 patients (38%) had never smoked, 38 patients (49%) had quitted smoking and 10 patients (13%) were still smoking. When the comorbid conditions were analysed, 14 patients were diagnosed as COPD, 17 patients (%22) as congestive heart failure, 24 patients (%31) as DM, 17 patients (%22) as cerebrovasculer diseases, 4 patients (%5) as malignite, 34 patients (%43.5) as HT, 4 patients (%5) as chronic renal failure and 13 patients (%17) as CVD respectively. 12 patients (15.3%) were not vaccinated influenza and 3 of them (3.8%) were not vaccinated pneumococca. Age, sex, smoking habits, comorbid conditions, vaccination status for pneumococca and influenza were detected to have no effect on mortality. 10 patients required intensive care and within those patients 7 of them (70%) were lost. Need for intensive care was detected to be associated with mortality. CURB-65 and PSI scores were detected to be higher in the patients that were lost and high CURB- 65 was associated with mortality. The decrease in the leukocyte count between the 1.-4. days and 1.-7. days were detected to be statistically significant within the survivors. The decrease in CRP between 1.-4. and 1.-7. days within the survivors was meaningful. Within the non-survivors, the decrease in CRP between 1.-4. days was insignificant where as it was significant between 1.-7. days. Total protein and albumin levels were observed to decrease between 1.-7. days both in survivors and non-survivors. The amount of decrease was significantly lower in the survivors than it as in non-survivors. As discussed in the literature, urea level was observed to be significantly higher in the non-survivors in our study. The decrease in serum urea and serum creatinine levels between 1. and 7. days was also significant in the survivors. CURB-65 scores, which was detected to be associated with mortality in our study, was detected to be positively correlated with age, urea, troponin, D-dimer and urea-acid; and negatively correlated with total protein, albumin and fT3. Conclusion: The increase in CURB-65 score was observed to be associated with serum albumin, total protein, urea, sT3 and leukocyte count measured on the first day of hospitalization. Unexpectedly, level of CRP and sedimentation level measured on the first day of hospitalization had no affect with mortality. Insignificant decrease in leukocyte count, CRP, urea and creatinine levels on 1.-4 days and 1-7 days and high amount of decrease in total protein and albumin were shown to be associated with mortality. Serum albumin, total protein and sT3 levels were negatively correlated with CURB-65 and CRP. D-dimer and troponin levels were shown to be positively correlated with CURB-65 and urea levels and negatively correlated with albumin. Keyword: Community acquired pneumonia, Mortality