Five Risk Factors for 30-day Mortality in Patients With Pneumonia

Yuichiro Shindo, M.D., Ph.D. Visiting Researcher Department of Anesthesiology Washington University School of Medicine St. Louis, MO Assistant Professor Institute for Advanced Research, Nagoya University, Department of Respiratory Medicine, Nagoya University Graduate School of Medicine Showa-ku, Nagoya Japan

Dr. Yuichiro Shindo

MedicalResearch.com Interview with:
Yuichiro Shindo, M.D., Ph.D.
Assistant Professor
Institute for Advanced Research, Nagoya University,
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine
Showa-ku, Nagoya Japan

Medical Research: What is the background for this study? What are the main findings?

Dr. Shindo: Appropriate initial antibiotic treatment is essential for the treatment of pneumonia.  However, many patients may develop adverse outcomes, even if they receive appropriate initial antibiotics.  To our knowledge, there have been no studies that clearly demonstrated the risk factors in patients who receive appropriate antibiotic treatment.  If these factors are clarified, we can identify those patients with pneumonia for whom adjunctive therapy other than antibiotic treatment can prove beneficial in terms of improved outcomes.  This study aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotic treatment and elucidate potential candidates for adjunctive therapy.

In this study, the 30-day mortality in 579 pneumonia patients who received appropriate initial antibiotics was 10.5%.  The independent risk factors included albumin < 3.0 mg/dL, nonambulatory status, pH < 7.35, respiration rate ≥ 30/min, and blood urea nitrogen ≥ 20 mg/dL.  The 30-day mortality for the number of risk factors was 0.8% (0), 1.2% (1), 16.8% (2), 22.5% (3), and 43.8% (4–5).

Medical Research: What should clinicians and patients take away from your report?

Dr. Shindo: Physicians need to carefully identify these five risk factors for 30-day mortality in patients with pneumonia at diagnosis.  The cumulative number of the risk factors may be used by physicians to predict 30-day mortality.  Patients with two or more risk factors have a higher mortality risk even though they receive appropriate initial antibiotics.  Physicians need to select appropriate initial antibiotics for these patients and should consider adjunctive therapy other than antibiotic treatment at the same time.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Shindo: On the basis of results in previous human and animal studies, the risk factors for 30-day mortality may be associated with impaired immune status, e.g., reduced phagocytic functions of macrophages and neutrophils, reduced differentiation status of T cells, etc.  Therefore, pneumonia patients with two or more risk factors could be good targets for investigation of their immune status and the effect of immunomodulatory agent.  Regarding immunotherapies, researchers should discuss what kind of therapies patients would need, including boosting immune functions and anti-inflammatory strategy such as corticosteroids.  This is one of our future tasks.

Citation:

Risk factors for 30-day mortality in patients with pneumonia who receive appropriate initial antibiotics: an observational cohort study

Shindo, Yuichiro et al.

The Lancet Infectious Diseases , Volume 15 , Issue 9 , 1055 – 1065

Published Online: 02 July 2015

DOI: http://dx.doi.org/10.1016/S1473-3099(15)00151-6

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Yuichiro Shindo, M.D., Ph.D. (2015). Five Risk Factors for 30-day Mortality in Patients With Pneumonia 

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