The clinical characteristics and prognostic factors of community-acquired pneumonia patients with chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 CHEN Liang ¹ , HAN Xiudi ² , XING Xiqian ³ , ZHU Xiaoli ⁴ , ZHU Limei ⁵

1. Department of Infectious Disease, Beijing Jishuitan Hospital, Beijing 100096, P. R. China;
2. Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P. R. China;
3. Department of Respiratory and Critical Care Medicine, The 2^nd People’s Hospital of Yunnan Province, Kunming, Yunnan 650021, P. R. China;
4. Occupational Medicine and Toxicology Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, P. R. China;
5. Department of Chronic Disease and Infectious Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, P. R. China;

Corresponding author：

CHEN Liang, Email: chenliang1995@sina.com

Keywords：

Communuty-acquired pneumonia; Chronic obstructive pulmonary disease; Mortality; Risk factor

DOI：

10.7507/1671-6205.201810029

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Objectives To explore the clinical characteristics and risk factors for 30-day mortality of community-acquired pneumonia (CAP) patients with chronic obstructive pulmonary disease (COPD).Methods This was a multicentre, retrospective study. Data of patients hospitalized with CAP from four tertiary hospitals in Beijing, Shandong and Yunnan from January 1, 2013 to December 31, 2015 were reviewed. Patients with (COPD-CAP) and without (non COPD-CAP) COPD were compared, including demographic and clinical features, treatment and outcomes. Univariate analysis and multivariate Logistic regression analysis were performed to identify risk factors for 30-day mortality in COPD-CAP patients.Results Three thousand three hundred and sixty-six CAP patients were entered into final analysis, COPD-CAP accounted for 12.9% (435/3 366). Compared to non COPD-CAP patients, COPD-CAP patients were more male and more frequent with CURB-65 score 2 and pneumonia severity index (PSI) risk class Ⅲ to Ⅴ. Pseudomonas aeruginosa was the most common etiology and more common in COPD-CAP patients than non COPD-CAP patients. Though the proportion of respiratory failure and heart failure were higher in COPD-CAP patients, there was no significant difference in the 30-day mortality. The 30-day mortality of COPD-CAP patients was 5.7% (25/435). Logistic regression analysis confirmed aspiration (OR 9.505, 95%CI 1.483 - 60.983, P=0.018), blood procalcitonin ≥2.0 ng/mL (OR 5.934, 95%CI 1.162 - 30.304, P=0.032) and PSI risk class (OR 2.533, 95%CI 1.156 - 5.547, P=0.020) were independent risk factors for 30-day mortality in COPD-CAP patients.Conclusions COPD-CAP patients present specific characteristics. Besides PSI risk class, clinicians should pay high attention to the aspiration and blood procalcitonin, which could increase the 30-day mortality in COPD-CAP patients.

Citation： CHEN Liang, HAN Xiudi, XING Xiqian, ZHU Xiaoli, ZHU Limei. The clinical characteristics and prognostic factors of community-acquired pneumonia patients with chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(5): 409-417. doi: 10.7507/1671-6205.201810029 Copy

1.	Almirall J, Bolíbar I, Vidal J, et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J, 2000, 15(4): 757-763.
2.	Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol, 1993, 137(9): 977-988.
3.	Woodhead MA, Macfarlane JT, McCracken JS, et al. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet, 1987, 329(8534): 671-674.
4.	File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med, 2010, 122(2): 130-141.
5.	Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet, 2007, 370(9589): 741-750.
6.	Chapman KR, Mannino DM, Soriano JB, et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J, 2006, 27(1): 188-207.
7.	Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11): e442.
8.	Bordon J, Slomka M, Gupta R, et al. Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary disease: incidence, epidemiology and outcomes. Clin Microbiol Infect, 2019: pii: S1198-743X(19)30371-4.
9.	Cilloniz C, Polverino E, Ewig S, et al. Impact of age and comorbidity on cause and outcome in community-acquired pneumonia. Chest, 2013, 144(3): 999-1007.
10.	Gómez-Junyent J, Garcia-Vidal C, Viasus D, et al. Clinical features, etiology and outcomes of community-acquired pneumonia in patients with chronic obstructive pulmonary disease. PLoS One, 2014, 9(8): e105854.
11.	Liapikou A, Polverino E, Ewig S, et al. Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients. Eur Respir J, 2012, 39(4): 855-861.
12.	Cilli A, Erdem H, Karakurt Z, et al. Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality. J Crit Care, 2013, 28(6): 975-979.
13.	中国成人社区获得性肺炎诊断和治疗指南 (2016 版). 中国成人社区获得性肺炎诊断和治疗指南 (2016 版). 中华结核和呼吸杂志, 2016, 39(4): 241-242.
14.	Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J, 2019, 53(5): pii: 1900164.
15.	Jiang W, Wu M, Zhou J, et al. Etiologic spectrum and occurrence of coinfections in children hospitalized with community-acquired pneumonia. BMC Infect Dis, 2017, 17(1): 787.
16.	Chen L, Zhou F, Li H, et al. Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey. BMJ Open, 2018, 8(2): e018709.
17.	Bansal S, Kashyap S, Pal LS, et al. Clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh. Indian J Chest Dis Allied Sci, 2004, 46(1): 17-22.
18.	Huang HH, Zhang YY, Xiu QY, et al. Community-acquired pneumonia in Shanghai, China: microbial etiology and implications for empirical therapy in a prospective study of 389 patients. Eur J Clin Microbiol Infect Dis, 2006, 25(6): 369-374.
19.	Reechaipichitkul W, Lulitanond V, Tantiwong P, et al. Etiologies and treatment outcomes in patients hospitalized with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. Southeast Asian J Trop Med Public Health, 2005, 36(1): 156-161.
20.	Garcia-Vidal C, Fernandez-Sabe N, Carratala J, et al. Early mortality in patients with community-acquired pneumonia: causes and risk factors. Eur Respir J, 2008, 32(3): 733-739.
21.	Molinos L, Clemente MG, Miranda B, et al. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect, 2009, 58(6): 417-424.
22.	Rello J, Rodriguez A, Torres A, et al. Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia. Eur Respir J, 2006, 27(6): 1210-1216.
23.	Restrepo MI, Mortensen EM, Pugh JA, et al. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J, 2006, 28(2): 346-351.
24.	Chen D, Restrepo MI, Fine MJ, et al. Observational study of inhaled corticosteroids on outcomes for COPD patients with pneumonia. Am J Respir Crit Care Med, 2011, 184(3): 312-316.
25.	Malo de Molina R, Mortensen EM, Restrepo MI, et al. Inhaled corticosteroid use is associated with lower mortality for subjects with COPD and hospitalised with pneumonia. Eur Respir J, 2010, 36(4): 751-757.
26.	Festic E, Scanlon PD. Incident pneumonia and mortality in COPD patients. A double-effect of inhaled corticosteroids?. Am J Respir Crit Care Med, 2015, 191(2): 141-148.
27.	Clayton NA, Carnaby GD, Peters MJ, et al. Impaired laryngopharyngeal sensitivity in patients with COPD: the association with swallow function. Int J Speech Lang Pathol, 2014, 16(6): 615-623.
28.	Terada K, Muro S, Ohara T, et al. Abnormal swallowing reflex and COPD exacerbations. Chest, 2010, 137(2): 326-332.
29.	DiBardino DM, Wunderink RG. Aspiration pneumonia: a review of modern trends. J Crit Care, 2015, 30(1): 40-48.
30.	Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med, 2001, 344(9): 665-671.
31.	Lanspa MJ, Peyrani P, Wiemken T, et al. Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes. J Hosp Med, 2015, 10(2): 90-96.
32.	Kim JH, Seo JW, Mok JH, et al. Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia. Tuberc Respir Dis (Seoul), 2013, 74(5): 207-214.
33.	Krüger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J, 2008, 31(2): 349-355.
34.	Keramat F, Ghasemi Basir HR, Abdoli E, et al. Association of serum procalcitonin and C-reactive protein levels with CURB-65 criteria among patients with community-acquired pneumonia. Int J Gen Med, 2018, 11(1): 217-223.

1. Almirall J, Bolíbar I, Vidal J, et al. Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Respir J, 2000, 15(4): 757-763.
2. Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol, 1993, 137(9): 977-988.
3. Woodhead MA, Macfarlane JT, McCracken JS, et al. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet, 1987, 329(8534): 671-674.
4. File TM Jr, Marrie TJ. Burden of community-acquired pneumonia in North American adults. Postgrad Med, 2010, 122(2): 130-141.
5. Buist AS, McBurnie MA, Vollmer WM, et al. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet, 2007, 370(9589): 741-750.
6. Chapman KR, Mannino DM, Soriano JB, et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J, 2006, 27(1): 188-207.
7. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11): e442.
8. Bordon J, Slomka M, Gupta R, et al. Hospitalization due to community-acquired pneumonia in patients with chronic obstructive pulmonary disease: incidence, epidemiology and outcomes. Clin Microbiol Infect, 2019: pii: S1198-743X(19)30371-4.
9. Cilloniz C, Polverino E, Ewig S, et al. Impact of age and comorbidity on cause and outcome in community-acquired pneumonia. Chest, 2013, 144(3): 999-1007.
10. Gómez-Junyent J, Garcia-Vidal C, Viasus D, et al. Clinical features, etiology and outcomes of community-acquired pneumonia in patients with chronic obstructive pulmonary disease. PLoS One, 2014, 9(8): e105854.
11. Liapikou A, Polverino E, Ewig S, et al. Severity and outcomes of hospitalised community-acquired pneumonia in COPD patients. Eur Respir J, 2012, 39(4): 855-861.
12. Cilli A, Erdem H, Karakurt Z, et al. Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality. J Crit Care, 2013, 28(6): 975-979.
13. 中国成人社区获得性肺炎诊断和治疗指南 (2016 版). 中国成人社区获得性肺炎诊断和治疗指南 (2016 版). 中华结核和呼吸杂志, 2016, 39(4): 241-242.
14. Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J, 2019, 53(5): pii: 1900164.
15. Jiang W, Wu M, Zhou J, et al. Etiologic spectrum and occurrence of coinfections in children hospitalized with community-acquired pneumonia. BMC Infect Dis, 2017, 17(1): 787.
16. Chen L, Zhou F, Li H, et al. Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey. BMJ Open, 2018, 8(2): e018709.
17. Bansal S, Kashyap S, Pal LS, et al. Clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh. Indian J Chest Dis Allied Sci, 2004, 46(1): 17-22.
18. Huang HH, Zhang YY, Xiu QY, et al. Community-acquired pneumonia in Shanghai, China: microbial etiology and implications for empirical therapy in a prospective study of 389 patients. Eur J Clin Microbiol Infect Dis, 2006, 25(6): 369-374.
19. Reechaipichitkul W, Lulitanond V, Tantiwong P, et al. Etiologies and treatment outcomes in patients hospitalized with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. Southeast Asian J Trop Med Public Health, 2005, 36(1): 156-161.
20. Garcia-Vidal C, Fernandez-Sabe N, Carratala J, et al. Early mortality in patients with community-acquired pneumonia: causes and risk factors. Eur Respir J, 2008, 32(3): 733-739.
21. Molinos L, Clemente MG, Miranda B, et al. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect, 2009, 58(6): 417-424.
22. Rello J, Rodriguez A, Torres A, et al. Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia. Eur Respir J, 2006, 27(6): 1210-1216.
23. Restrepo MI, Mortensen EM, Pugh JA, et al. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J, 2006, 28(2): 346-351.
24. Chen D, Restrepo MI, Fine MJ, et al. Observational study of inhaled corticosteroids on outcomes for COPD patients with pneumonia. Am J Respir Crit Care Med, 2011, 184(3): 312-316.
25. Malo de Molina R, Mortensen EM, Restrepo MI, et al. Inhaled corticosteroid use is associated with lower mortality for subjects with COPD and hospitalised with pneumonia. Eur Respir J, 2010, 36(4): 751-757.
26. Festic E, Scanlon PD. Incident pneumonia and mortality in COPD patients. A double-effect of inhaled corticosteroids?. Am J Respir Crit Care Med, 2015, 191(2): 141-148.
27. Clayton NA, Carnaby GD, Peters MJ, et al. Impaired laryngopharyngeal sensitivity in patients with COPD: the association with swallow function. Int J Speech Lang Pathol, 2014, 16(6): 615-623.
28. Terada K, Muro S, Ohara T, et al. Abnormal swallowing reflex and COPD exacerbations. Chest, 2010, 137(2): 326-332.
29. DiBardino DM, Wunderink RG. Aspiration pneumonia: a review of modern trends. J Crit Care, 2015, 30(1): 40-48.
30. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med, 2001, 344(9): 665-671.
31. Lanspa MJ, Peyrani P, Wiemken T, et al. Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes. J Hosp Med, 2015, 10(2): 90-96.
32. Kim JH, Seo JW, Mok JH, et al. Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia. Tuberc Respir Dis (Seoul), 2013, 74(5): 207-214.
33. Krüger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J, 2008, 31(2): 349-355.
34. Keramat F, Ghasemi Basir HR, Abdoli E, et al. Association of serum procalcitonin and C-reactive protein levels with CURB-65 criteria among patients with community-acquired pneumonia. Int J Gen Med, 2018, 11(1): 217-223.

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