Community acquired pneumonia: Risk factors associated with mortality in a tertiary care hospitalized patients

Objective: To evaluate risk factors associated with mortality in patients hospitalized with Community Acquired Pneumonia (CAP) from a developing country. Methods: An observational study was conducted on adult patients admitted with a diagnosis of CAP from January 2002 to August 2003 at Aga Khan University hospital, Karachi, Pakistan. Clinical records were reviewed for demographic characteristics, clinical and laboratory features, hospital course, and risk factors associated with mortality. Results: A total of 329 patients (187 males) were admitted with CAP. Two-third of patients had underlying co-morbid medical illnesses. Complications developed in 15.7% cases and the overall mortality rate was 11%. Risk factors were identified on initial clinical assessment, laboratory and radiological features and during hospital course. On admission elevated blood urea, new onset of confusion, abnormal liver function test, low serum albumin, cardiomegaly and presence of underlying malignancy were strongly associated with increased mortality. Failure to respond to therapy was associated with a high risk of mortality as depicted by complication during hospital stay (Odds Ratio= 23.3, 95% Confidence Interval= 10.3-52.8), need for mechanical ventilation (OR= 17.1, 95%CI= 7.4-39.8) and need for intensive care unit (OR= 9, 95%CI= 4.2-19.3). Conclusions: Abnormal liver function test, low albumin and presence of cardiomegaly were more significant mortality risk factors than age, respiratory rate and blood pressure. Elevated blood urea and confusion remain strong risk factors on admission. Failure of response to therapy and onset of complications heralded a high risk of death.