Analysis of the In-hospital Mortality in Patients with Community-acquired Pneumonia

Introduction: Community-acquired pneumonia (CAP) is a common disease with frequent hospitalization and still high mortality rate. Aim: To analyze the clinical characteristics of patients who died in the hospital from CAP. Materials and Methods: 1292 patients hospitalized in the Clinic of Pneumonology and Phthisiatrics of MHAT “Saint Marina” – Varna were retrospectively studied for the period 2012 to 2015. Data were analyzed with statistical program SPSS.20. Results: 148 patients (11.5%) died during the hospital stay. The non-survivors were significantly older than the survivors (67.6±14.2 vs. 58.9±17.1 years, p<0.001). No significant difference in the mortality rate between male and female was proven (12.3 % vs. 10.3 %, р=0.15). Charlson comorbidity index was significantly higher in non-survivors compared to survivors (3.28±2.21 vs. 1.36±1.63, p<0.001). Patients with dementia, carcinoma with metastases and cerebrovascular disease as concomitant comorbidities had the highest risk of dying in the hospital (OR 6.86 (3.97-11.84); 4.33 (1.43-13.12); 4.05 (2.77-5.92) resp. p<0.05) C-reactive protein was also significantly higher in non-survivors compared to survivors (171.85±83.17mg/L vs.123.42±99.68mg/L, р<0.001). The most common complication was acute respiratory failure (89.9%). Of the deceased patients 16.9% did not meet the criteria for severe CAP according to IDSA/ATS on admission. Most of the deceased patients (52%) died within the first 3 days of the hospital stay. Conclusion: Older patients with comorbidities had higher risk of dying in the hospital. Patients with CAP need intensified monitoring especially in the first 3 days even if they do not have severe pneumonia on admission.