title: Decrease in long-term survival for hospitalized patients with community-acquired pneumonia.
abstract: BACKGROUND
  The association of hospitalization because of community-acquired pneumonia (CAP) and long-term survival has not been fully examined. We measured the long-term survival of hospitalized patients with CAP adjusted for the effects of comorbidities.
  
  
  METHODS
  A cohort of adult patients admitted to the medical services of the Veterans Affairs Medical Center, Louisville, Kentucky, was retrospectively examined. A Kaplan-Meier survival curve was constructed to assess the effect of CAP admission status on patient survival. A Cox proportional hazards regression model included comorbidities as predictors and time to death as the outcome in the construction of a modified Charlson Comorbidity Index (mCCI). The mCCI was internally validated to evaluate the predictability of patient survival. The mCCI and age > 65 years were included as potential confounders in a final Cox proportional hazards regression model with CAP admission status as the main predictor and time to death as the outcome.
  
  
  RESULTS
  CAP was identified in 624 (9%) out of 6,971 patients. The Kaplan-Meier survival curve showed a significantly shorter survival among patients with CAP than those without CAP (P < .0001). The internal validation of the mCCI showed that patients were more likely to die as the mCCI increased (P < .0001). The Cox proportional hazards regression modeling the association between time to death and CAP admission after adjusting for elderly age and the mCCI showed that hospitalization due to CAP was a statistically significant predictor of decreased survival (hazard ratio, 1.4; 95% CI, 1.2-1.5; P < .0001).
  
  
  CONCLUSIONS
  There is a decreased long-term survival among hospitalized patients with CAP after adjusting for comorbidities and aging. Future research to understand the pathophysiology of the long-term CAP outcomes is necessary to develop treatment strategies.
authors.affiliation: Division of Infectious Diseases, University of Louisville Medical School, Louisville, KY 20017, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Bordon
authors.forename: Timothy
authors.initials: T
authors.lastname: Wiemken
authors.forename: Paula
authors.initials: P
authors.lastname: Peyrani
authors.forename: Maria Luz
authors.initials: ML
authors.lastname: Paz
authors.forename: Martin
authors.initials: M
authors.lastname: Gnoni
authors.forename: Patricio
authors.initials: P
authors.lastname: Cabral
authors.forename: Maria del Carmen
authors.initials: Mdel C
authors.lastname: Venero
authors.forename: Julio
authors.initials: J
authors.lastname: Ramirez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome