Non-bacteremic pneumococcal pneumonia: general characteristics and early predictive factors for poor outcome.

ABSTRACT

Purpose: Nowadays, most cases of pneumococcal community-acquired pneumonia (PCAP) are diagnosed by positive urinary antigen. Our aims were to analyse process of care in patients hospitalised with non-bacteremic PCAP (NB-PCAP) and identify factors associated with poor outcome (PO) in this population.Methods: We conducted a prospective study, including patients hospitalised for NB-PCAP (positive urinary antigen and negative blood culture) over a 15 year period. We performed multivariate analysis of predisposing factors for PO, defined as need for mechanical ventilation and/or shock and/or in-hospital death.Results: Of the 638 patients included, 4.1% died in hospital and 12.8% had PO. Host-related factors were similar in patients with and without PO, but patients with PO had higher illness severity on admission. Adjusted analysis revealed the following independent factors associated with PO being a nursing home resident (OR 6.156; 95% CI 1.827-20.750; p = .003), respiratory rate ≥30 breaths/min (OR 3.030; 95% CI 1.554-5.910; p = .001), systolic blood pressure <90 mmHg (OR 4.789; 95% CI 1.967-11.660; p = .001), diastolic blood pressure <60 mmHg (OR 2.820; 95% CI 1.329-5.986; p = .007), pulse rate ≥125 beats/min (OR 3.476; 95% CI 1.607-7.518; p = .002), pH <7.35 (OR 9.323; 95% CI 3.680-23.622; p < .001), leukocytes <4000/µL (OR 10.007; 95% CI 2.960-33.835; p < .001), and severe inflammation (OR 2.364; 95% CI 1.234-4.526; p = .009). The area under the curve for predicting PO was 0.890 (95% CI 0.851-0.929).Conclusions: Since patients with PO seem different and had worse in-hospital course, we identified eight independent risk factors for PO measurable on admission.