title: Risk factors for 30-day mortality in patients with pneumonia who receive appropriate initial antibiotics: an observational cohort study.
abstract: BACKGROUND
  Appropriate initial antibiotics are essential for the treatment of infectious diseases. However, some patients with pneumonia might develop adverse outcomes, despite receiving appropriate initial antibiotics. We aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotics and to identify potential candidates who would benefit from adjunctive therapy.
  
  
  METHODS
  From March 15, to Dec 22, 2010, we did a prospective, observational study at ten medical institutions in hospitalised patients (aged ≥20 years) with pneumonia. We did a multivariable logistic regression analysis to calculate odds ratios (ORs) and 95% CI to assess the risk factors for 30-day mortality. This study was registered with the University Medical Information Network in Japan, number UMIN000003306.
  
  
  RESULTS
  The 30-day mortality was 11% (61 of 579 patients) in the appropriate initial antibiotic treatment group and 17% (29 of 168) in the inappropriate initial antibiotic treatment group. Albumin concentration of less than 30 mg/L (adjusted OR 3·39, 95% CI 1·83-6·28), non-ambulatory status (3·34, 1·84-6·05), pH of less than 7·35 (3·13, 1·52-6·42), respiration rate of at least 30 breaths per min (2·33, 1·28-4·24), and blood urea nitrogen of at least 7·14 mmol/L (2·20, 1·13-4·30) were independent risk factors in patients given appropriate initial antibiotic treatment. The 30-day mortality was 1% (one of 126 patients), 1% (two of 168), 17% (23 of 137), 22% (20 of 89), and 44% (14 of 32) for patients with no, one, two, three, and four or five risk factors, respectively.
  
  
  CONCLUSIONS
  Patients with two or more risk factors were at a higher risk of death during the 30 days assessed than were individuals with no or one risk factor, despite appropriate initial antibiotic treatment. Therefore, adjunctive therapy might be important for improving outcomes in patients with two or more risk factors.
  
  
  BACKGROUND
  Central Japan Lung Study Group.
authors.affiliation: Institute for Advanced Research, Nagoya University, Nagoya, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: yshindo@med.nagoya-u.ac.jp.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shindo
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Respiratory Medicine, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Ito
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.affiliation: Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.affiliation: Department of Respiratory Medicine and Allergy, Toyota Kosei Hospital, Toyota, Japan; Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan.
authors.forename: Motoshi
authors.initials: M
authors.lastname: Ichikawa
authors.affiliation: Department of Respiratory Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan; Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Respiratory Medicine, Toyohashi Municipal Hospital, Toyohashi, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Fukui
authors.affiliation: Department of Respiratory Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Iwaki
authors.affiliation: Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Okumura
authors.affiliation: Department of Central Laboratory, Toyohashi Municipal Hospital, Toyohashi, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Yamaguchi
authors.affiliation: Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yagi
authors.affiliation: Department of Respiratory Medicine and Allergy, Toyota Kosei Hospital, Toyota, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Tanikawa
authors.affiliation: Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan.
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Sugino
authors.affiliation: Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Joe
authors.initials: J
authors.lastname: Shindoh
authors.affiliation: Department of Respiratory Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Ogasawara
authors.affiliation: Department of Respiratory Medicine, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Nomura
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Saka
authors.affiliation: Department of Respiratory Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Department of Respiratory Medicine, Toyohashi Municipal Hospital, Toyohashi, Japan.
authors.forename: Ryujiro
authors.initials: R
authors.lastname: Suzuki
authors.affiliation: Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saito
authors.affiliation: Kyoto University Health Service, Kyoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D001806:Blood Urea Nitrogen; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D057970:Inappropriate Prescribing; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality*; D011446:Prospective Studies; D012372:ROC Curve; D056152:Respiratory Rate; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D016138:Walking
chemical_list: D000900:Anti-Bacterial Agents; D012709:Serum Albumin