Background

Some studies have reported that long-term prognosis after pneumonia is poor. Our aim was to determine predictors of long-term outcomes with special attention to community-acquired pneumonia (CAP) etiology.

Methods

We studied 1930 patients who were hospitalized with CAP from January 2002 through November 2017 at Saitama Cardiovascular and Respiratory Center and were discharged alive. We conducted a retrospective study for calculation of survival rate using the Kaplan-Meier method and analysis of prognostic factors by multivariate analysis using a Cox proportional hazard model.

Results

The median follow-up period was 442.5 (range 1–5514) days. During this period, 321 patients died. Median survival time was 11.9 years, and 1-year and 5-year survival rates were 93.8% and 74.0%, respectively. Among the patients’ demographics factors, old age, poor performance status (PS) score, pneumococcal vaccination history, some underlying respiratory diseases, and chronic heart failure were significant independent factors of poor prognosis. Among pathogens, Streptococcus pneumoniae (hazard ratio [HR]: 1.35, 95% confidence interval [CI]: 1.03, 3.07, P = 0.038) and Pseudomonas aeruginosa (HR: 1.68, 95% CI: 1.07, 2.64, P = 0.024) were significant independent factors of poor prognosis, whereas influenza virus tended to predict a good prognosis (HR: 0.60, 95% CI: 0.36, 1.02, P = 0.058). Respiratory disease accounted for 59% of all causes of death after CAP, and the rate of death from pneumonia was the largest at 22%.

Conclusion

Not only age, general condition, and comorbidities but also specific pathogens were predictors of long-term prognosis after hospital discharge for CAP.

中文翻译：

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特定病原体作为社区获得性肺炎出院后长期预后不良的预测因素

背景

一些研究报道，肺炎后的长期预后很差。我们的目标是确定长期结果的预测因素，特别关注社区获得性肺炎 (CAP) 的病因。

方法

我们研究了 2002 年 1 月至 2017 年 11 月在埼玉心血管和呼吸中心住院并活着出院的 1930 名 CAP 患者。我们进行了使用 Kaplan-Meier 方法计算存活率的回顾性研究，并使用 Cox 比例风险模型通过多变量分析来分析预后因素。

结果

中位随访期为 442.5（范围 1-5514）天。在此期间，有 321 名患者死亡。中位生存时间为 11.9 年，1 年和 5 年生存率分别为 93.8% 和 74.0%。在患者的人口统计学因素中，高龄、PS评分差、肺炎球菌疫苗接种史、一些基础呼吸系统疾病和慢性心力衰竭是预后不良的显着独立因素。在病原体中，肺炎链球菌（风险比 [HR]：1.35，95% 置信区间 [CI]：1.03、3.07，P = 0.038）和铜绿假单胞菌(HR: 1.68, 95% CI: 1.07, 2.64, P = 0.024) 是预后不良的重要独立因素，而流感病毒倾向于预测良好的预后 (HR: 0.60, 95% CI: 0.36, 1.02, P = 0.058 ）。呼吸系统疾病占 CAP 后所有死因的 59%，肺炎死亡率最高，为 22%。

结论

不仅年龄、一般状况和合并症，而且特定病原体也是 CAP 出院后长期预后的预测因素。