[Mortality and prognostic factors in patients with community-acquired pneumonia: an analysis of 231 cases]

We prospectively analyzed the mortality and prognostic factors in 231 patients with community-acquired pneumonia. The patients were enrolled between May 1996 and April 1998. The average patient age was 67.6 +/- 17.5 years, and 68% were male. The mean hospital length of stay was 21.9 +/- 21.7 days. The mortality was 6.5% at the 30th day, 13.9% at hospital discharge, and 19.9% at 1 year later. Stepwise logistic regression analysis showed that liver cirrhosis, diastolic hypotension (< 60 mmHg), hypoxemia (< 50 Torr) were significantly correlated with death at the 30th day, and that alcoholism, malignancy, diastolic hypotension, hypoxemia, hypoalbuminemia (< 3.0 g/dl), and increased creatinine (> 1.2 mg/dl) were significantly correlated with discharge mortality. Furthermore, the prognostic factors at 1 year later were the same as those at hospital discharge, with the exception of alcoholism, which was replaced by ischemic heart disease in the 1-year mortality. We conclude that liver cirrhosis, diastolic hypotension, and hypoxemia are very important prognostic factors during the acute stage of pneumonia, and that alcoholism, malignancy, hypoalbuminemia and renal complications are significantly correlated with hospital death and 1-year mortality.

[Community-acquired pneumococcal pneumonia: a comparative study of bacteremic and nonbacteremic patients]

We analyzed the clinical and laboratory features of 37 adult patients with community-acquired pneumococcal pneumonia requiring hospitalization. Blood culture was positive in 11, and negative in 26. The average age of the 37 patients was 70.2 years, and 28 were male. Compared with the patients with negative blood culture, the patients with positive blood culture were more likely to have liver cirrhosis, less sputum production, lower body temperature, and higher respiratory rate on physical examination. In the laboratory data on admission, the values for serum total protein, albumin, and glucose were significantly lower in the patients with positive blood culture. Thirty-two percent of the pneumococcal isolates were resistant to penicillin G (MIC > or = 0.12 microgram/ml). There was no difference in the frequency of drug-resistant pneumococci in the two groups. The use of mechanical ventilation was more frequent in the patients with positive blood culture than in the patients with negative blood culture (27.3% vs 3.8%). Moreover, mortality was higher (27.3% vs 7.7%) and the duration of hospitalization was longer in the bacteremic group. However, from a univariate analytical perspective, these differences were not significant. We concluded that blood culture can be a highly valuable diagnostic aid and useful for the prognostic evaluation of patients with community-acquired pneumonia requiring hospitalization.

[Comparative study of clinical features of typical and atypical pneumonias]

We prospectively analyzed the clinical and laboratory features of 74 patients with community-acquired pneumonia who required hospitalization between May 1996 and October 1997. Typical pathogens were identified in 47, and atypical pathogens in 27. The average age was higher in patients affected by typical pathogens (73.9 years), than in patients affected by atypical pathogens (50.9 years). Univariable analysis found that atypical pneumonias were more frequent in healthy patients than typical pneumonias. Moreover, the presence of relatives with symptoms of airway infection, headache, and earache was more common among the patients with atypical pneumonias, while leukocytosis and elevated C-reactive protein levels were more frequent among patients with typical pneumonias. Typical pathogens accounted for up to 79.6% of the cases of pneumonia with in older patients (aged 60 years or more), whereas atypical pathogens accounted for up to 80% of the cases of pneumonia in younger patients (aged under 60 years). This difference was statistically significant. Of all 74 patients, 39 (52.7%) were afflicted by severe community-acquired pneumonia, as categorized by American Thoracic Society guidelines. The most common pathogen among these patients was Streptococcus pneumoniae. Legionella was one of the top four. Selection of the initial antimicrobial treatment is an important clinical decision that should be made on the basis of clinical features at admission, age, and severity of the patient's illness.