Highlights
- •Incidence of hospitalizations for pneumonia were higher in COPD-patients.
- •In hospital mortality was significantly lower among COPD patients with CAP.
- •No differences in mortality for NV-HAP or VAP among COPD and non-COPD patients.
- •Age and undergoing dialysis are risk factors for mortality in all types of pneumonia.
Abstract
Background
To examine the incidence, characteristics and outcomes of community-acquired pneumonia
(CAP), ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumonia
(NV-HAP) in patients with or without COPD; compare in-hospital outcomes; and identify
factors associated with in-hospital mortality (IHM) for pneumonia.
Methods
We carried out a retrospective observational study using the hospital discharge records
from 2016-17 of the Spanish National Health System. Propensity score matching was
used for data analysis.
Results
We found 245,905 patients (≥40 years) with pneumonia; we identified CAP in 228,139
patients (19.85% with COPD), VAP in 2,771 patients (8.55% with COPD) and NV-HAP in
14,995 patients (14.17% with COPD). The incidence for the three types of pneumonia
was higher in COPD patients (CAP: incidence rate ratio (IRR) 2.23, 95% CI 2.21-2.26;
VAP: IRR 1.25, 95% CI 1.08-1.42; and NV-HAP: IRR 1.55, 95% CI 1.48-1.63). The IHM
for CAP was 10.35% in COPD patients and 12.91% in the controls (p<0.001). In patients
with VAP and NV-HAP, IHM was not significantly different between those with and without
COPD (43.88% vs. 41.77%;p=0.643 and 29.21% vs. 30.57%;p=0.331, respectively). Factors
associated with IHM for all types of pneumonia analyzed in COPD patients were older
age and receiving dialysis.
Conclusions
The incidence of hospitalizations for all types of pneumonia was significantly higher
in COPD patients than in the non-COPD population. In contrast, IHM was significantly
lower among COPD patients with CAP than among matched non-COPD patients. Higher mortality
rates in COPD patients with any pneumonia type were associated with increasing age
and receiving dialysis.
Keywords
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References
- Community-acquired pneumonia and hospital-acquired pneumonia.Med Clin North Am. 2019; 103: 487-501https://doi.org/10.1016/j.mcna.2018.12.008
- Clinical and economic burden of community-acquired pneumonia among adults in Europe.Thorax. 2012; 67: 71-79https://doi.org/10.1136/thx.2009.129502
- Community-acquired pneumonia requiring hospitalization among U.S. adults.N Engl J Med. 2015; 373: 415-427https://doi.org/10.1056/NEJMoa1500245
- Trends in hospitalizations for pneumonia among persons aged 65 years or older in the United States, 1988-2002.JAMA. 2005; 294: 2712-2719https://doi.org/10.1001/jama.294.21.2712
- Increasing hospital admissions for pneumonia, England.Emerg Infect Dis. 2008; 14: 727-733https://doi.org/10.3201/eid1405.071011
- Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014.Thorax. 2016; : 71535-71542https://doi.org/10.1136/thoraxjnl-2015-207688
- Impact of COPD on outcomes in hospitalized patients with community-acquired pneumonia: analysis of the Spanish national hospital discharge database (2004-2013).Eur J Intern Med. 2017; 43: 69-76https://doi.org/10.1016/j.ejim.2017.06.008
- Decreasing incidence and mortality among hospitalized patients suffering a ventilator-associated pneumonia: analysis of the Spanish national hospital discharge database from 2010 to 2014.Medicine (Baltimore). 2017; 96: e7625https://doi.org/10.1097/MD.0000000000007625
- Hospital-acquired pneumonia. Spanish society of pulmonology and thoracic surgery (SEPAR) guidelines. 2019 update.Arch Bronconeumol. 2020; 56 (Suppl): 11-19https://doi.org/10.1016/j.arbres.2020.01.015
- Developing a new, national approach to surveillance for ventilator-associated events: executive summary.Clin Infect Dis. 2013; 57: 1742-1746https://doi.org/10.1093/cid/cit577
- Epidemiology of ICU-acquired pneumonia.Curr Opin Crit Care. 2018; 24: 325-331https://doi.org/10.1097/MCC.0000000000000536
- The epidemiology of nonventilator hospital-acquired pneumonia in the United States.Am J Infect Control. 2018; 46: 322-327https://doi.org/10.1016/j.ajic.2017.09.005
- Pneumonia in patients with chronic obstructive pulmonary disease.Tuberc Respir Dis (Seoul). 2018; 81: 187-197https://doi.org/10.4046/trd.2018.0030
- Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 1998; 157: 1418-1422https://doi.org/10.1164/ajrccm.157.5.9709032
- Influence of pneumonia on the survival of patients with COPD.J Clin Med. 2020; 9: 230https://doi.org/10.3390/jcm9010230
- Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients.Eur Respir J. 2012; 39: 855-861https://doi.org/10.1183/09031936.00067111
- Etiology and factors contributing to the severity and mortality of community-acquired pneumonia.Intern Med. 2013; 52: 317-324https://doi.org/10.2169/internalmedicine.52.8830
- Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia.Thorax. 2009; 64: 592-597https://doi.org/10.1136/thx.2008.105080
- Pulmonary complications of pneumococcal community-acquired pneumonia: incidence, predictors, and outcomes.Clin Microbiol Infect. 2012; 18: 1134-1142https://doi.org/10.1111/j.1469-0691.2011.03692.x
- Is COPD associated with increased mortality and morbidity in hospitalized pneumonia? A systematic review and meta-analysis.Respirology. 2015; 20: 1046-1054https://doi.org/10.1111/resp.12597
- Seasonality, risk factors and burden of community-acquired pneumonia in COPD patients: a population database study using linked health care records.Int J Chron Obstruct Pulmon Dis. 2017; 12: 313-322https://doi.org/10.2147/COPD.S121389.eCollection2017
- Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.Thorax. 2009; 64: 863-868https://doi.org/10.1136/thx.2009.115725
Ministerio de sanidad, consumo y bienestar social. registro de actividad de atención especializada. RAE-CMBD. https://www.mscbs.gob.es/estadEstudios/estadisticas/cmbdhome.htm. [accessed 05.31.2020].
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2020 report. Available at:www.goldcopd.org[accessed 05.31.2020].
- Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003-2009.JAMA. 2012; 307: 1405-1413https://doi.org/10.1001/jama.2012.384
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383https://doi.org/10.1016/0021-9681(87)90171-8
- Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.Med Care. 2005; 43: 1130-1139https://doi.org/10.1097/01.mlr.0000182534.19832.83
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399-424https://doi.org/10.1080/00273171.2011.568786
- Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.Stat Med. 1998; 17: 2265-2281
- doi:10.1002/(sici)1097-0258(19981015)17:19<2265::aid-sim918>3.0.co;2-b.
Leuven E, Sianesi B.PSMATCH2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. https://econpapers.repec.org/software/bocbocode/s432001.htm. [accessed 05.31.2020].
- Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.Pharm Stat. 2011; 10: 150-161https://doi.org/10.1002/pst.433
Instituto nacional de estadística. encuesta nacional de salud 2017. [Spanish National Health Survey 2017]https://www.mscbs.gob.es/estadEstudios/estadisticas/encuestaNacional/encuesta2017.htm[accessed 05.31.2020].
Instituto nacional de estadística: national stadistical institute. population estimates 2016. https://www.ine.es./dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736176951&menu=ultiDatos&idp=1254735572981[accessed 05.31.2020].
- Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples.Stat Med. 2011; 30: 1292-1301https://doi.org/10.1002/sim.4200
- Nationwide trends in pneumonia hospitalization rates and mortality, Denmark 1997-2011.Respir Med. 2014; 108: 1214-1222https://doi.org/10.1016/j.rmed.2014.05.004
- Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary disease: incidence, epidemiology and outcomes.Clin Microbiol Infect. 2020; 26: 220-226https://doi.org/10.1016/j.cmi.2019.06.025
- Postoperative pneumonia among patients with and without COPD in Spain from 2001 to 2015.Eur J Intern Med. 2018; 53: 66-72https://doi.org/10.1016/j.ejim.2018.02.011
- COPD patients with ventilator-associated pneumonia: implications for management.Eur J Clin Microbiol Infect Dis. 2015; 34: 2403-2411https://doi.org/10.1007/s10096-015-2495-6
- Chronic obstructive pulmonary disease and the risk for ventilator-associated pneumonia.Curr Opin Crit Care. 2014; 20 (Oct): 525-531https://doi.org/10.1097/MCC.0000000000000123
- Identifying the associated risks of pneumonia in COPD patients: ARCTIC an observational study.Respir Res. 2018; 19: 172https://doi.org/10.1186/s12931-018-0868-y
De Miguel-Díez J, Jiménez-García R, Hernández-Barrera V, Puente-Maestu L, Ji Z, de Miguel-Yanes JM, et al. Ventilatory support use in hospitalized patients with community-acquired pneumonia. Fifteen-year trends in Spain (2001-2015). Arch Bronconeumol. 2020; S0300-2896(19)30614-3. doi: 10.1016/j.arbres.2019.12.008.
- Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure.Eur Respir J. 2017; 501602426https://doi.org/10.1183/13993003.02426-2016
- The role of noninvasive positive pressure ventilation in community-acquired pneumonia.J Crit Care. 2015; 30: 49-54https://doi.org/10.1016/j.jcrc.2014.09.021
- The clinical and economic burden of pneumonia in patients enrolled in Medicare receiving dialysis: a retrospective, observational cohort study.BMC Nephrol. 2016; 17: 199https://doi.org/10.1186/s12882-016-0412-6
- Trends in pathogens among patients hospitalized for pneumonia from 1993 to 2011.JAMA Intern Med. 2014; 174: 1837-1839https://doi.org/10.1001/jamainternmed.2014.4344
- Determining the contribution of Streptococcus pneumoniae to community-acquired pneumonia in Australia.Med J Aust. 2017; 207: 396-400https://doi.org/10.5694/mja16.01102
- The relationship between ventilator-associated pneumonia and chronic obstructive pulmonary disease: what is the current evidence?.Eur J Clin Microbiol Infect Dis. 2019; 38: 637-647https://doi.org/10.1007/s10096-019-03486-2
- Impact of ventilator-associated pneumonia on outcome in patients with COPD.Chest. 2005; 128: 1650-1656https://doi.org/10.1378/chest.128.3.1650
- The impact of COPD on ICU mortality in patients with ventilator-associated pneumonia.Respir Med. 2011; 105: 1022-1029https://doi.org/10.1016/j.rmed.2011.03.001
- Impact of chronic obstructive pulmonary disease on incidence, microbiology and outcome of ventilator-associated lower respiratory tract infections.Microorganisms. 2020; 8 (pii): E165https://doi.org/10.3390/microorganisms8020165
- New perspectives on community-acquired pneumonia in 388 406 patients.Result Nationwide Mandat Perform Meas Program Healthc Qual. Thorax. 2009; 64: 1062-1069https://doi.org/10.1136/thx.2008.109785
- The outcome of community-acquired pneumonia in patients with chronic lung disease: a case-control study.Swiss Med Wkly. 2014; 144 (eCollection 2014): w14013https://doi.org/10.4414/smw.2014.14013
- Pneumonia mortality, comorbidities matter?.Pulmonology. 2019; 26: 123-129https://doi.org/10.1016/j.pulmoe.2019.10.003
- Nosocomial pneumonia in 27 ICUs in Europe: perspectives from the EU-VAP/CAP study.Eur J Clin Microbiol Infect Dis. 2017; 36: 1999-2006https://doi.org/10.1007/s10096-016-2703-z
- Increased severity and mortality of CAP in COPD: results from the German competence network, CAPNETZ.Chronic Obstr Pulm Dis. 2015; 2: 131-140https://doi.org/10.15326/jcopdf.2.2.2014.0149
- Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD.Thorax. 2012; 67: 117-121https://doi.org/10.1136/thoraxjnl-2011-200332
- Efficacy and safety of corticosteroids for community-acquired pneumonia: a systematic review and meta-analysis.Chest. 2016; 149: 209-219https://doi.org/10.1378/chest.15-1733
- Efficacy and safety of adjunctive corticosteroids therapy for patients with severe community-acquired pneumonia: a systematic review and meta-analysis.Medicine (Baltimore). 2019; 98: e14636https://doi.org/10.1097/MD.0000000000014636
Article info
Publication history
Published online: June 29, 2020
Accepted:
June 25,
2020
Received in revised form:
June 22,
2020
Received:
April 3,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
