Surviving pneumonia may only provide a short-term lease on a future healthy life

Researchers have shown that the subsequent 2 to 3 years after discharge from the hospital following treatment for pneumonia may provide only a short-term lease on a future healthy life if the patient has certain significant and independent predictors of mortality.

Writing in the second issue for April 2004 of the American Thoracic Society’s peer-reviewed American Journal of Respiratory and Critical Care Medicine, Grant W. Waterer, M.B.B.S., F.R.A.C.P., Department of Medicine, University of Western Australia, Perth, along with 2 associates, ascertained the survival status of 366 community-acquired pneumonia patients who were hospitalized at Methodist Healthcare Memphis Hospital, Memphis, Tennessee. The investigators showed that increasing age, together with accompanying cardiovascular and cerebrovascular disease, presence of an altered mental state, and anemia (hematocrit of less than 35 percent) were significant and independent predictors of mortality in the subsequent 2 to 3 years after hospital discharge for pneumonia.

In their research, the investigators were able to ascertain the survival status of 97 percent of the patients in the study over an average of 3 years after discharge. Death occurred in 125 patients after discharge from the hospital.

According to the authors, the primary concern of their study was the issue raised in a prior study by other investigators who noted that an episode of community-acquired pneumonia is an adverse prognostic marker for medium-to-long-term survival. In their study, they found no apparent excess medium-term mortality in the 18- to 40-year-old former pneumonia patients who had no other accompanying diseases.

"However, there was a trend toward higher mortality in all older age groups with no comorbid illnesses, especially the 41- to 60-year age group,” said Dr. Waterer. “This trend is even more concerning when the fact is considered that the expected mortality rate is based on population data that includes subjects with significant comorbidities. Although the lack of statistical significance may be reassuring, our data do not exclude the possibility that an episode of community-acquired pneumonia may be a sentinel event for increased mortality in a subgroup of patients."

In an editorial in the same issue on the subject, Scott F. Dowell, M.D., M.P.H., of the International Emerging Infections Program, Thai Ministry of Public Health and the U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand, wrote: “Waterer and coworkers provide a useful contribution to a growing body of evidence indicating that patients who survive hospitalization for pneumonia can expect a mortality rate that is modestly to substantially increased over the subsequent 1 to 4 years.”

Dr. Dowell pointed out that it appeared an increased risk of death "may persist for several years after an episode of pneumonia. To patients and their families, this argues for continuing vigilance, and attention to preventive measures with sustained benefits."

He added: "The prognosis for modern day patients who recover from a first bout of pneumonia may be substantially improved by offering an effective smoking cessation program, influenza vaccine, and pneumoccal vaccine. The most recent guidelines for management of pneumonia by U.S. and Canadian infectious disease and thoracic societies already endorse such recommendations, but the implementation remains poor. Only 55 percent of adults 65 years or older reported receiving the pneumoccal vaccine in 2002, and the proportion was even lower among nursing home residents (38 percent) and 18- to 64-year-old subjects with high-risk conditions (17 percent)."

He noted that standing hospital discharge orders by all physicians caring for pneumonia patients would be an effective means of improving vaccination rates for influenza and pneumonia (pneumoccal vaccine); plus providing a start to a smoking cessation program for those who need it..