title: Increased long-term mortality after survival of invasive pneumococcal disease: a population-based study.
abstract: OBJECTIVE
  We studied if patients surviving hospitalization for invasive pneumococcal disease (IPD) have an increased long-term mortality.
  
  
  METHODS
  In this population-based case-control study, we assessed adults discharged from Aker University Hospital in Oslo, Norway, from 1993 to 2008 after surviving IPD. Mortality among the study population was compared to the general Norwegian population using standardized mortality ratios (SMR). Median follow-up time was 7.2 years (range 5 days to 21.1 years). Associated factors were also investigated.
  
  
  RESULTS
  We assessed 372 patients of whom 184 patients died during the observation period. Mortality was increased for 10 years after surviving hospitalization for IPD. Patients aged 18-64 years had a one-year SMR of 18.8 (95% CI: 10.0-32.1) and a 10-year SMR of 6·0 (95% CI: 4.4-8.0). SMR for the first five years among patients with and without underlying conditions were 10.7 (95% CI: 7.0-15.5) and 2.8 (95% CI: 0.9-6.4), respectively. Patients older than 65 years had a one-year SMR of 1·8 (95% CI: 1.2-2.7) and a 10-year SMR of 1.6 (95% CI: 1.4-1.9).
  
  
  CONCLUSIONS
  Patients surviving IPD had an increased long-term mortality compared to the general population. This was particularly pronounced in patients with known underlying conditions. These findings suggest that IPD is a negative prognostic marker, and that a closer follow-up of patients who have suffered IPD is warranted.
authors.affiliation: a Department of Infectious Disease , Oslo University Hospital , Oslo , Norway.|b Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway.
authors.forename: Hans Kristian
authors.initials: HK
authors.lastname: Floeystad
authors.affiliation: b Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway.|c Department of Respiratory Medicine , Oslo University Hospital , Oslo , Norway.
authors.forename: Are
authors.initials: A
authors.lastname: Holm
authors.affiliation: d Faculty of Odontology , University of Oslo , Oslo , Norway.|e Oslo Group of Biostatistics and Epidemiology, Oslo University Hospital , Oslo , Norway.
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: f Department of Infection Control and Environmental Health , Norwegian Institute of Public Health , Oslo , Norway.
authors.forename: Didrik Frimann
authors.initials: DF
authors.lastname: Vestrheim
authors.affiliation: g Department of Internal Medicine , Lovisenberg Hospital , Oslo, Norway.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Brandsaeter
authors.affiliation: a Department of Infectious Disease , Oslo University Hospital , Oslo , Norway.|b Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo , Norway.
authors.forename: Dag
authors.initials: D
authors.lastname: Berild
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Mortality; pneumococcal; sepsis