Predictors of in-hospital mortality and length of stay in community-acquired pneumonia: a 5-year multi-centre case control study of adults in a developing country.
We investigated predictors of in-hospital mortality and length of hospital stay among adults with community-acquired pneumonia (CAP) in Nigeria in order to provide recommendations to improve CAP outcomes in developing countries.



This was a multi-centre case control study of patients ≥18 years who were admitted with CAP between 2008 and 2012. Case notes of 100 consecutive patients who died (cases) and random sample of 300 patients discharged (controls) were selected.



Mean ages were 55.4±19.6 (cases) and 49.3±19.2 (controls). Independent predictors of mortality were CURB-65 score ≥3: adjusted odds ratio (aOR) 24.3, late presentation: aOR 8.6, co-morbidity: aOR 3.9, delayed first dose antibiotics (>4 hours): aOR 3.5, need for supplemental oxygen: aOR 4.9, multilobar pneumonia: aOR 4.0, non-pneumococcal aetiology: aOR 6.5, anaemia: aOR 3.8 and hyperglycemia: aOR 8.6. CURB-65 ≥3 predicted mortality with a high specificity (96.1%) but low sensitivity (75%); positive predictive value of 88.2% and negative predictive value of 90.8%. Care in hospital A and B: aOR 3.3 and 2.2 respectively, male gender aOR 2.1, co-morbidity aOR 3.0, anaemia aOR 2.1 and elevated serum creatinine aOR 6.3 independently predicted length of hospital stay >10 days among survivors.



Several modifiable patient-related and process-of-care factors predicted in-hospital mortality, and length of hospital stay among survivors. Our findings should be used to improve CAP outcomes in developing countries.
Department of Medicine, College of Medicine, University of Nigeria Ituku/Ozalla, PMB 01129 Enugu, Nigeria Department of Internal Medicine, Federal Medical Centre Owerri, PMB 1010 Owerri, Imo State, Nigeria mikezindu@yahoo.com michael.iroezindu@unn.edu.ng.
Michael O
MO
Iroezindu
Department of Medicine, Federal Teaching Hospital Abakaliki, PMB 102 Abakaliki, Ebonyi State, Nigeria.
Godsent C
GC
Isiguzo
Department of Medicine,Federal Medical Centre Umuahia, PMB 7001 Umuahia, Abia State, Nigeria.
Emmanuel I
EI
Chima
Department of Internal Medicine, Federal Medical Centre Owerri, PMB 1010 Owerri, Imo State, Nigeria.
Godwin C
GC
Mbata
Department of Medical Microbiology, University of Jos, PMB 2083 Jos, Plateau State, Nigeria.
Kenneth I
KI
Onyedibe
Department of Medicine, College of Medicine, University of Nigeria Ituku/Ozalla, PMB 01129 Enugu, Nigeria.
Cajetan C
CC
Onyedum
Department of Internal Medicine, Federal Medical Centre Owerri, PMB 1010 Owerri, Imo State, Nigeria.
Obiageli J
OJ
John-Maduagwu
Department of Internal Medicine, Federal Medical Centre Owerri, PMB 1010 Owerri, Imo State, Nigeria.
Leo E
LE
Okoli
Department of Medicine, College of Medicine, University of Nigeria Ituku/Ozalla, PMB 01129 Enugu, Nigeria.
Ekenechukwu E
EE
Young
D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003695:Delivery of Health Care; D003906:Developing Countries; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010100:Oxygen / Q000097:blood; D011014:Pneumonia / Q000150:complications / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D013296:Streptococcus pneumoniae
D000900:Anti-Bacterial Agents; D003404:Creatinine; D010100:Oxygen
Community-acquired pneumonia; Developing countries; Length of hospital stay; Mortality; Nigeria; Predictors