title: Does prolonged onset of symptoms have a prognostic significance in community-acquired pneumonia?
abstract: OBJECTIVE
  Severity assessment is made at the time of the initial clinical presentation in patients with community-acquired pneumonia (CAP). It is unclear how the gap between time of presentation and duration of symptoms onset may impact clinical outcomes. Here we evaluate the association of prolonged onset of symptoms (POS) and the impact on clinical outcomes among hospitalized patients with CAP.
  
  
  METHODS
  This was a prospective, multicentre study of CAP in Spain. The primary outcomes were the clinical factors associated with POS defined as days from symptoms onset to pneumonia diagnosis >7 days. The secondary outcomes were intensive care unit (ICU) admission, the presence of suppurative complications, septic shock and 30-day mortality.
  
  
  RESULTS
  We enrolled 1038 patients diagnosed of CAP: 152 (14.6%) patients had a POS. In multivariate analysis, the presence of prior corticosteroid therapy, alcohol abuse, prior antibiotic therapy, and confusion, urea, respiratory rate, blood pressure and age 65 years or older score 0-1 was independently associated with POS. Patients with POS had a higher incidence of suppurative complications, but not of 30-day mortality when compared with a shorter onset of symptoms.
  
  
  CONCLUSIONS
  Approximately 15% of patients diagnosed with CAP had POS. Risk factors associated with POS were previous corticosteroids and antibiotic therapy, alcoholism and less severe pneumonia. POS was associated with a higher rate of suppurative complications and less need for ICU admission.
authors.affiliation: Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sanz
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: Estrella
authors.initials: E
authors.lastname: Fernández-Fabrellas
authors.forename: Angela
authors.initials: A
authors.lastname: Cervera
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Briones
authors.forename: Laura
authors.initials: L
authors.lastname: Novella
authors.forename: María Carmen
authors.initials: MC
authors.lastname: Aguar
authors.forename: Eusebi
authors.initials: E
authors.lastname: Chiner
authors.forename: Juan F
authors.initials: JF
authors.lastname: Fernandez
authors.forename: José
authors.initials: J
authors.lastname: Blanquer
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D017714:Community-Acquired Infections; D057210:Delayed Diagnosis; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D016952:Legionella pneumophila; D008297:Male; D008875:Middle Aged; D009177:Mycoplasma pneumoniae; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011024:Pneumonia, Viral / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D011379:Prognosis; D013030:Spain; D013296:Streptococcus pneumoniae; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic; community-acquired pneumonia; complication; outcome; risk factor