title: The prognostic significance of respiratory rate in patients with pneumonia: a retrospective analysis of data from 705,928 hospitalized patients in Germany from 2010-2012.
abstract: BACKGROUND
  Measurement of the respiratory rate is an important instrument for assessing the severity of acute disease. The respiratory rate is often not measured in routine practice because its clinical utility is inadequately appreciated. In Germany, documentation of the respiratory rate is obligatory when a patient with pneumonia is hospitalized. This fact has enabled us to study the prognostic significance of the respiratory rate in reference to a large medical database.
  
  
  METHODS
  We retrospectively analyzed data from the external quality-assurance program for community-acquired pneumonia for the years 2010-2012. All patients aged 18 years or older who were not mechanically ventilated on admission were included in the analysis. Logistic regression was used to determine the significance of the respiratory rate as a risk factor for in-hospital mortality.
  
  
  RESULTS
  705,928 patients were admitted to the hospital with community-acquired pneumonia (incidence: 3.5 cases per 1000 adults per year). The in-hospital mortality of these patients was 13.1% (92 227 persons). The plot of mortality as a function of respiratory rate on admission was U-shaped and slanted to the right, with the lowest mortality at a respiratory rate of 20/min on admission. If patients with a respiratory rate of 12-20/min are used as a baseline for comparison, patients with a respiratory rate of 27-33/min had an odds ratio (OR) of 1.72 for in-hospital death, and those with a respiratory rate above 33/min had an OR of 2.55. Further independent risk factors for in-hospital death were age, admission from a nursing home, hospital, or rehabilitation facility, chronic bedridden state, disorientation, systolic blood pressure, and pulse pressure.
  
  
  CONCLUSIONS
  Respiratory rate is an independent risk marker for in-hospital mortality in community-acquired pneumonia. It should be measured when patients are admitted to the hospital with pneumonia and other acute conditions.
authors.affiliation: Department of Medicine 1 - Gastroenterology, Pneumology and Endocrinology, Universitätsklinikum Erlangen.
authors.forename: Richard
authors.initials: R
authors.lastname: Strauß
authors.affiliation: Centre for Thoracic Diseases in the Ruhr Area, EVK Herne and Augusta-Kranken-Anstalt Bochum, Departments of Pneumology and Infectious Diseases, Bochum.
authors.forename: Santiago
authors.initials: S
authors.lastname: Ewig
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care GmbH Göttingen.
authors.forename: Klaus
authors.initials: K
authors.lastname: Richter
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care GmbH Göttingen.
authors.forename: Thomas
authors.initials: T
authors.lastname: König
authors.affiliation: AQUA - Institute for Applied Quality Improvement and Research in Health Care GmbH Göttingen.
authors.forename: Günther
authors.initials: G
authors.lastname: Heller
authors.affiliation: Helios Klinikum Emil von Behring, Berlin.
authors.forename: Torsten T
authors.initials: TT
authors.lastname: Bauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000401:mortality*; D011379:Prognosis; D015203:Reproducibility of Results; D056152:Respiratory Rate; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D055815:Young Adult