title: Tobacco smoking increases the risk for death from pneumococcal pneumonia.
abstract: BACKGROUND
  Active smoking increases the risk of developing community-acquired pneumonia (CAP) and invasive pneumococcal disease, although its impact on mortality in pneumococcal CAP outcomes remains unclear. The aim of this study was to investigate the influence of current smoking status on pneumococcal CAP mortality.
  
  
  METHODS
  We performed a multicenter, prospective, observational cohort study in 4,288 hospitalized patients with CAP. The study group consisted of 892 patients with pneumococcal CAP: 204 current smokers (22.8%), 387 nonsmokers (43.4%), and 301 exsmokers (33.7%).
  
  
  RESULTS
  Mortality at 30 days was 3.9%: 4.9% in current smokers vs 4.3% in nonsmokers and 2.6% in exsmokers. Current smokers with CAP were younger (51 years vs 74 years), with more alcohol abuse and fewer cardiac, renal, and asthma diseases. Current smokers had lower CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) scores, although 40% had severe sepsis at diagnosis. Current smoking was an independent risk factor (OR, 5.0; 95% CI, 1.8-13.5; P = .001) for 30-day mortality of pneumococcal CAP after adjusting for age (OR, 1.06; P = .001), liver disease (OR, 4.5), sepsis (OR, 2.3), antibiotic adherence to guidelines, and first antibiotic dose given < 6 h. The independent risk effect of current smokers remained when compared only with nonsmokers (OR, 4.0; 95% CI, 1.3-12.6; P = .015) or to exsmokers (OR, 3.9; 95% CI, 1.09-4.95; P = .02).
  
  
  CONCLUSIONS
  Current smokers with pneumococcal CAP often develop severe sepsis and require hospitalization at a younger age, despite fewer comorbid conditions. Smoking increases the risk of 30-day mortality independently of tobacco-related comorbidity, age, and comorbid conditions. Current smokers should be actively targeted for preventive strategies.
authors.affiliation: The Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, Spain. Electronic address: sbello@salud.aragon.es.
authors.forename: Salvador
authors.initials: S
authors.lastname: Bello
authors.affiliation: Servicio de Neumología, IIS Hospital Universitario la Fe, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menéndez
authors.affiliation: Servei de Pneumologia, Institut Clinic del Torax, Universitat de Barcelona, Ciberes GRS, Barcelona, Spain.
authors.forename: Torres
authors.initials: T
authors.lastname: Antoni
authors.affiliation: Servicio de Neumología, IIS Hospital Universitario la Fe, Valencia, Spain.
authors.forename: Soledad
authors.initials: S
authors.lastname: Reyes
authors.affiliation: Servicio de Neumología, Hospital de Cruces, Bilbao, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Zalacain
authors.affiliation: Servicio de Neumología, Hospital de Galdakao, Galdakao, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Capelastegui
authors.affiliation: Servicio de Neumología, Hospital de la Princesa Spain, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Aspa
authors.affiliation: Servicio de Neumología, Hospital San Jorge, Huesca, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Borderías
authors.affiliation: Servicio de Neumología, Hospital Carlos Haya, Málaga, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Martin-Villasclaras
authors.affiliation: Servicio de Neumología, Hospital de Valme, Sevilla, Spain.
authors.forename: Immaculada
authors.initials: I
authors.lastname: Alfageme
authors.affiliation: Servicio de Neumología, Hospital Dr Negrín, Las Palmas de Gran Canaria, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Rodríguez de Castro
authors.affiliation: Critical Care, Hospital Vall d'Hebron, Institut de Recerca Vall d'Hebron-UAB, CIBERES, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Servicio de Neumología, Hospital Central de Asturias, Oviedo, Spain.
authors.forename: Molinos
authors.initials: M
authors.lastname: Luis
authors.affiliation: Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz-Manzano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D015996:Survival Rate