The influence of COPD on mortality and severity scoring in community-acquired pneumonia.
BACKGROUND
Chronic obstructive lung disease (COPD) is a frequent co-morbidity in patients hospitalised with community-acquired pneumonia (CAP). In recent retrospective studies, higher mortality in patients with CAP and COPD was found.


OBJECTIVE
The aim of the study was to determine the 30-day mortality and to evaluate the differences in CAP severity scoring in hospitalised patients with COPD.


METHODS
A subanalysis of a randomized clinical trial was performed.


RESULTS
A total of 262 patients with CAP were included. Ninety-five (36.3%) patients had COPD. A total of 28 (10.7%) patients died within 30 days. No differences between patients with and without COPD in 30-day mortality were observed [8 (8.4%) vs. 20 (12.0%), p = 0.37]. In the Pneumonia Severity Index (PSI), significant differences in age, gender and heart rate between patients with and without COPD were observed. Patients with COPD were stratified in higher PSI classes. In the CURB-65 score, age >or=65 years was significantly higher in patients with COPD [72 (75.8%) vs. 88 (52.7%), p = <0.01]. In a multivariate analysis, only the need for intensive care unit admission and high serum glucose were predictors of mortality [OR 32.50 (95% CI 6.87-153.75), p < 0.01; OR 7.34 (95% CI 1.19-45.4), p = 0.03].


CONCLUSIONS
Mortality was not increased in patients with COPD hospitalised with CAP. Severity scores are influenced by age and gender. Further studies evaluating CAP in patients with COPD are needed to explain these findings.
Department of Pulmonary Diseases, Medical Center Alkmaar, Alkmaar, The Netherlands.
Dominic
D
Snijders
Menno
M
van der Eerden
Casper
C
de Graaff
Wim
W
Boersma
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011014:Pneumonia / Q000150:complications / Q000382:microbiology / Q000401:mortality*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality*; D012720:Severity of Illness Index