A local perspective on risk factors and short term outcomes in community-acquired pneumonia

Aim: To identify which risk factors affect short term outcome in adult patients hospitalised with radiologically confirmed community-acquired pneumonia (CAP) in the main tertiary care hospital in Malta. Method: All adult patients who were admitted with a radiologically diagnosed CAP for 3 consecutive years were included in this retrospective observational study. Aspiration or health-care associated pneumonia were excluded. Data collected included demographic data, comorbidities, baseline parameters and radiological zones involved on CXR. In-hospital stay was monitored to record duration, complications, level of care required and outcome in terms of morbidity and 30 day mortality. Results: Our cohort included 211 patients(mean age 77±12,59% males) and their CURB-65 score was 0:10.4%,1:24.1%,2: 41.7%,3:16.5%,4:6.6%,5:0.005% of patients. An increase in 30-day mortality was significantly associated with increasing age (p=0.01), a CURB-65 score of 4 (p=0.05) and radiological extent of pneumonia (p=0.01). Logistic regression identified significant association between increased mortality and CURB-65 (OR 15, 95%CI:5.1-44.2 for CURB-65 score of 3 and OR13.2, 95%CI:3.07-56.6 for CURB-65 score of 4), radiological severity of pneumonia (OR 2.76, 95%CI:1.3-5.8), and increasing age (OR1.03, 95%CI:1.002-1.06). The presence of co-morbidities including diabetes, chronic lung,kidney and liver disease, congestive heart failure, immunosuppression as well as gender and smoking history did not show statistical significance on univariate analysis. Conclusion: Early identification and treatment of local CAP patients at risk of increased morbidity and mortality can help decrease complications and improve outcomes.