Elsevier

Journal of Infection

Volume 58, Issue 6, June 2009, Pages 417-424
Journal of Infection

Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease

https://doi.org/10.1016/j.jinf.2009.03.003Get rights and content

Summary

Purpose

The purpose of this study was to analyse the possible differences, especially those regarding mortality, between patients hospitalized for community-acquired pneumonia (CAP) with and without chronic obstructive pulmonary disease (COPD), and the risk factors related to mortality in the COPD group.

Methods

710 patients with CAP were included in a prospective multicenter observational study. 244 of the patients had COPD confirmed by spirometry.

Results

COPD was associated with mortality in patients with CAP (OR = 2.62 CI: 1.08–6.39). Patients with COPD and CAP had a significantly higher 30-day mortality rate as compared to patients without COPD. Multivariate analysis showed that PaO2  60mmHg (OR = 7.95; 95% CI: 3.40–27.5), PaCO2  45 mm Hg (OR = 4.6; CI: 2.3–15.1); respiratory rate ≥30/min (OR = 12.25; CI: 3.45–35.57), pleural effusion (OR = 8.6; 95% CI: 2.01–24.7), septic shock (OR = 12.6; 95% CI: 3.4–45.66) and renal failure (OR = 13.4; 95% CI: 3.2–37.8) were significantly related to mortality. Purulent sputum and fever were considered as protective factors.

Conclusions

COPD was an independent risk factor for mortality in patients with CAP. Hypoxemia and hypercapnia are associated with mortality in patients with CAP with and without COPD. Chronic obstructive pulmonary disease and PaCO2 value could be useful prognostic factors and should be incorporated in risk stratification in patients with CAP.

Section snippets

Patients

From April 2003 to April 2004, a prospective multicenter observational study was carried out in seven hospitals in Asturias (Spain). The cohort comprised all patients admitted with community-acquired pneumonia. Exclusion criteria included patients admitted within the previous 15 days, and patients with severe immunosuppression, such as neutropenia (<500/mm3), human immunodeficiency virus (HIV) infection, solid organ or bone marrow transplants, treatment with steroids in doses >20 mg

Patient characteristics

We include 710 patients with CAP, mean age 67.14 (CI: 95%, 65.9–68.4). 244 had a concomitant clinical diagnosis of COPD, compared with 466 patients who did not have COPD. The main demographic characteristics, comorbidities, clinical data, and PSI index for each group as well as COPD severity and other features are shown in Table 1. COPD patients with CAP were significantly older, predominantly male, with higher PSI scores, alcohol drinkers, and ex-smokers. Diabetes and corticosteroid therapy

Discussion

In this study we compared CAP patients with and without COPD. Previous studies had no control group.5, 6, 7 In other studies,9 the definition of COPD was not based on pulmonary function tests, nor were they classified by degrees of severity.10 In our study, the CAP group with COPD had higher PSIs, explained by their older mean age, male predominance and some comorbidities like diabetes, hypoxemia and acidemia due to hypercapnia. Our results were similar to the other report.9

In our experience,

Conflict of interest

The authors have no conflict of interest to declare.

Acknowledgements

The authors acknowledge the comments and suggestions from A. Torres.

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