Outcomes and Predictors of Severe Community-acquired Pneumonia Among Adults Admitted to the University of Gondar Comprehensive Specialized Hospital: A Prospective Follow-up Study

Abstract

Background

Severe community-acquired pneumonia is a common life-threatening infection with a high rate of unfavorable outcome. This study aimed to assess the outcomes and predictors of hospitalized severe community-acquired pneumonia patients at University of Gondar comprehensive specialized hospital.

Methods

A prospective follow-up study was conducted at University of Gondar comprehensive specialized hospital from May 1 to September 31, 2021. The data was collected by reviewing patients’ charts and interviewing the patients themselves. Descriptive statistics, binary and multivariable logistic regression analysis were performed accordingly. Variables with p-value <0.2 on binary logistic regression were analyzed using multivariable logistic regression and variables with p<0.05 were considered to have significant association.

Results

A total of 239 admitted patients with severe community-acquired pneumonia were enrolled in the study. An unfavorable outcome was observed in 105 (44%) patients; 24.27% was in-hospital all-cause mortality, 12.5% was nonresolution, 5.8% was complicated cases, and 1.26% were gone against medical care for poor prognosis. After analyzing multivariable logistic regression, confusion (OR= 4.84; 95%CI: 1.47–15.88), anemia (OR= 2.36; 95%CI: 1.01–5.52), leukopenia (OR=4.38; 95%CI: 1.26–15.25), leukocytosis (OR=3.15; 95%CI: 1.23–7.96), elevated creatinine (OR=5.67; 95%CI: 1.72–18.65), intubation (OR=7.27; 95%CI: 1.58–33.37) and antibiotic revision during treatment for a different reason (OR=0.02; 95%CI: 0.01–0.07) were variables significantly associated with unfavorable outcome.

Conclusion

Unfavorable outcome was high among hospitalized severe community acquired pneumonia patients, and confusion, elevated creatinine, anemia, leukopenia, leukocytosis, intubation during admission, and antibiotic revision during the course were independent predictors associated significantly with the unfavorable outcome. It is important to consider the development of a treatment protocol for the hospital and to further research incorporating the microbiologic profile of the patients.

Keywords:

• pneumonia
• unfavorable outcome
• community-acquired pneumonia
• Ethiopia

Abbreviations

AIDS, acquired immunodeficiency syndrome; AOR, adjusted odds ratio; ATS, American Thoracic Society; ART, anti-retroviral therapy; CAP, community-acquired pneumonia; CBC, complete blood count; CI, confidence interval; CURB 65, confusion, urea, respiratory rate, blood pressure and age >65; COPD, chronic obstructive pulmonary disease; CLD, chronic liver disease; CKD, chronic kidney disease; ED, emergency department; EMCC, emergency medicine and critical care; FIO₂, fraction of inspired oxygen; GCS, Glasgow coma scale; GP, general practitioner; UOGCSH, University of Gondar Comprehensive Specialized Hospital; HIV, human immunodeficiency virus; ICU, intensive care unit; IDSA, Infectious Disease Society Association; ILD, interstitial lung disease; IQR, interquartile range; MUAC, mid-upper arm circumference; p, probability-value; PCCM, pulmonologist and critical care management; PSI, pneumonia severity index; PaO₂, partial arterial oxygen; RCT, randomized control trial; US, United States; WBC, white blood count.

Data Sharing Statement

The datasets supporting the conclusions of this article are available upon request to the primary/corresponding author.

Acknowledgments

The authors would like to acknowledge University of Gondar college of Medicine and Health Science, School of Medicine for giving us the opportunity to conduct this study. Our acknowledgment would also extend to health professionals who work at the Department of Internal Medicine for their cooperativeness in the data collection process.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors declare that they have no conflicts of interest in relation to this work.

Additional information

Funding

The authors received no specific funding for this work.