Predictores clínicos de mortalidad en el seguimiento a mediano plazo en pacientes adultos inmunocompetentes hospitalizados por neumonía adquirida en la comunidad.

Resumen

PREDICTORS OF ONE YEAR MORTALITY AMONG IMMUNOCOMPETENT ADULTS HOSPITALIZED FOR COMMUNITY-ACQUIRED PNEUMONIA.

Background: Mortality increases in adults, especially in older adults, after recovery from an episode of community-acquired pneumonia (CAP). Aim: To analyze survival and predictors of death at one year follow up of a cohort of adult patients hospitalized with CAP. Material and methods: Immunocompetent patients admitted to a clinical hospital for an episode of CAP were included in the study and were assessed according to a standardized protocol. One year mortality after admission was assessed using death records of the National Identification Service. Clinical and laboratory variables measured at hospital admission associated with risk of death at one year follow up were subjected to univariate and multivariate analysis by a logistic regression model. Results: We evaluated 659 patients aged 68 ± 19 years, 52% were male, 77% had underlying conditions (especially cardiovascular, neurological and respiratory diseases). Mean hospital length of stay was 9 days, 7.1% died during hospital stay and 15.8% did so during the year of follow-up. A causal agent was identified in one third of cases. The main pathogens isolated were Streptococcus pneumoniae (12.9%), Haemophilus influenzae (4.1%), respiratory viruses (6.5%) and gram-negative bacilli (6, 5%). In multivariate analysis, the clinical variables associated with increased risk of dying during the year of follow-up were older age, chronic neurological disease, malignancies, lack of fever at admission and prolonged hospital length of stay. Conclusions: Age, specific co morbidities such as  chronic neurological disease and cancer, absence of fever at hospital admission and prolonged hospital length of stay were associated with increased risk of dying during the year after admission among adult patients hospitalized with community-acquired pneumonia.