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Editor's Correspondence
November 25, 2002

Causes of Death for Patients With Community-Acquired Pneumonia

Arch Intern Med. 2002;162(21):2491. doi:

Studying the causes of death within 90 days of presentation in 2287 patients with community-acquired pneumonia (CAP), Mortensen et al1 found that almost half of the deaths (98 of 208) were attributable to pneumonia-unrelated causes. To the knowledge of Mortensen et al, no previous study has focused on different causes of death in patients with CAP. However, there is a Swedish study by Hedlund et al2 that should be mentioned in this context. Performing a follow-up at 31 months after hospitalization for CAP, these investigators found that 51 (21%) of 241 patients had died since discharge compared with 26 (11%) in an average Swedish population of equal size and age distribution during the same period (relative risk of death, 2.0; 95% confidence interval, 1.4-3.2). The cause of death was considered pneumonia related in 13 (25%) of the 51 deaths in the pneumonia cohort. Among the pneumonia-unrelated causes of death, vascular diseases and malignancies were dominate causes. The substantial 2.5-year mortality found in this study by Hedlund et al should be compared with the 90-day mortality rate of 14% among inpatients in the study by Mortensen et al.1 In a previous large outcome meta-analysis,3 the overall mortality rate in patients with CAP was 13.7%, although the time to follow-up was provided for only 28 (22%) of the 127 cohorts studied. This meta-analysis showed that a number of comorbid illnesses, such as neoplastic disease, neurologic disease, and congestive heart failure, are significantly associated with mortality in patients with CAP. However, the studies by Mortensen et al1 and Hedlund et al2 indicate that, although patients are affected by CAP toward the end of their lives, they quite often die from other conditions. Accordingly, CAP seems to be a risk factor for both pneumonia-related and pneumonia-unrelated mortality.

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