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For patients with community-acquired pneumonia, only half of all deaths are attributable to their acute illness, and more than 75 percent of these deaths occur within the first 30 days after the patient is seen, according to a study by the Pneumonia Patient Outcomes Research Team (PORT). The researchers found that deaths unrelated to pneumonia occurred later than pneumonia-related deaths and differed in the underlying and immediate causes of death, as well as the clinical predictors of death. Knowing these differences is important for evaluating the quality of pneumonia care, which is reflected in pneumonia-related deaths, explains PORT co-principal investigator Michael J. Fine, M.D., M.S.C., of the University of Pittsburgh.
With support from the Agency for Healthcare Research and Quality (HS06468 and National Research Service Award fellowship F32 HS00135), Pneumonia PORT principal investigator Wishwa N. Kapoor, M.D., M.P.H., Eric M. Mortensen, M.D., M.Sc., of the University of Pittsburgh, and their colleagues used a five-member review panel to analyze all deaths (two panel members each time) of 944 outpatients and 1,343 inpatients within 90 days of pneumonia diagnosis. A total of 208 patients (9 percent) died within 90 days. Death was pneumonia-related in 53 percent of the deaths.
Pneumonia-related deaths were nearly eight times as likely to occur within 30 days of pneumonia diagnosis compared with deaths unrelated to pneumonia; only 15 percent of all pneumonia-related deaths occurred after 45 days. Other factors independently associated with pneumonia-related death were hypothermia, altered mental status, elevated serum urea nitrogen level, chronic liver disease, leukopenia (reduced white blood cell count), and hypoxemia (low blood oxygen level). In contrast, factors independently associated with deaths unrelated to pneumonia were dementia, suppression of the immune system, active cancer, systolic hypotension, male sex, and multilobar pulmonary infiltrates. Older age and evidence of aspiration independently predicted both types of deaths.
See "Causes of death for patients with community-acquired pneumonia," by Dr. Mortensen, Christopher M. Coley, M.D., Daniel E. Singer, M.D., and others, in the May 13, 2002, Archives of Internal Medicine 162, pp. 1059-1064.
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