Semin Respir Crit Care Med 2024; 45(02): 266-273
DOI: 10.1055/s-0044-1781426
Review Article

Long-Term Outcomes in Severe Community-Acquired Pneumonia

Francesco Carella
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
2   Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
2   Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Anna Stainer
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
2   Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Antonio Voza
1   Department of Biomedical Sciences, Humanitas University, Milan, Italy
3   Emergency Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Francesco Blasi
4   Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
5   Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
› Author Affiliations

Abstract

Community-acquired pneumonia (CAP) is globally one of the major causes of hospitalization and mortality. Severe CAP (sCAP) presents great challenges and need a comprehensive understanding of its long-term outcomes. Cardiovascular events and neurological impairment, due to persistent inflammation and hypoxemia, contribute to long-term outcomes in CAP, including mortality. Very few data are available in the specific population of sCAP. Multiple studies have reported variable 1-year mortality rates for patients with CAP up to 40.7%, with a clear influence by age, comorbidities, and disease severity. In terms of treatment, the potential protective role of macrolides in reducing mortality emphasizes the importance of appropriate empiric antibiotic therapy. This narrative review explores the growing interest in the literature focusing on the long-term implications of sCAP. Improved understanding of long-term outcomes in sCAP can facilitate targeted interventions and enhance posthospitalization care protocols.



Publication History

Article published online:
23 February 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. Lancet 2021; 398 (10303): 906-919
  • 2 Martin-Loeches I, Torres A, Nagavci B. et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia. Intensive Care Med 2023; 49 (06) 615-632
  • 3 Ramirez JA, Wiemken TL, Peyrani P. et al; University of Louisville Pneumonia Study Group. Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality. Clin Infect Dis 2017; 65 (11) 1806-1812
  • 4 Restrepo MI, Reyes LF, Anzueto A. Complication of community-acquired pneumonia (including cardiac complications). Semin Respir Crit Care Med 2016; 37 (06) 897-904
  • 5 Uranga A, Quintana JM, Aguirre U. et al. Predicting 1-year mortality after hospitalization for community-acquired pneumonia. PLoS One 2018; 13 (02) e0192750
  • 6 Tokgoz Akyil F, Yalcinsoy M, Hazar A. et al. Prognosis of hospitalized patients with community-acquired pneumonia. Pulmonology 2018; 17 :S2173-5115 (17) 30156-2
  • 7 Nair GB, Niederman MS. Updates on community acquired pneumonia management in the ICU. Pharmacol Ther 2021; 217: 107663
  • 8 Aliberti S, Brambilla AM, Chalmers JD. et al. Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis. Respir Res 2014; 15 (01) 27
  • 9 Mandell LA, Wunderink RG, Anzueto A. et al; Infectious Diseases Society of America, American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl. 02) S27-S72
  • 10 Torres A, Chalmers JD, Dela Cruz CS. et al. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Med 2019; 45 (02) 159-171
  • 11 Charles PGP, Wolfe R, Whitby M. et al; Australian Community-Acquired Pneumonia Study Collaboration. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47 (03) 375-384
  • 12 Lee JC, Hwang HJ, Park YH, Joe JH, Chung JH, Kim SH. Comparison of severity predictive rules for hospitalised nursing home-acquired pneumonia in Korea: a retrospective observational study. Prim Care Respir J 2013; 22 (02) 149-154
  • 13 España PP, Capelastegui A, Gorordo I. et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med 2006; 174 (11) 1249-1256
  • 14 Di Pasquale MF, Sotgiu G, Gramegna A. et al; GLIMP Investigators. Prevalence and etiology of community-acquired pneumonia in immunocompromised patients. Clin Infect Dis 2019; 68 (09) 1482-1493
  • 15 Restrepo MI, Jorgensen JH, Mortensen EM, Anzueto A. Severe community-acquired pneumonia: current outcomes, epidemiology, etiology, and therapy. Curr Opin Infect Dis 2001; 14 (06) 703-709
  • 16 Angus DC, Marrie TJ, Obrosky DS. et al. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria. Am J Respir Crit Care Med 2002; 166 (05) 717-723
  • 17 Leroy O, Santré C, Beuscart C. et al. A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit. Intensive Care Med 1995; 21 (01) 24-31
  • 18 The British Thoracic Society Research Committee and The Public Health Laboratory Service. The aetiology, management and outcome of severe community-acquired pneumonia on the intensive care unit. Respir Med 1992; 86 (01) 7-13
  • 19 Myint PK, Hawkins KR, Clark AB. et al. Long-term mortality of hospitalized pneumonia in the EPIC-Norfolk cohort. Epidemiol Infect 2016; 144 (04) 803-809
  • 20 Surme S, Balkan II, Bayramlar OF. et al. Predictors of long-term outcomes in the older adults with community-acquired pneumonia. J Infect Dev Ctries 2021; 15 (12) 1910-1916
  • 21 Johnstone J, Eurich DT, Majumdar SR, Jin Y, Marrie TJ. Long-term morbidity and mortality after hospitalization with community-acquired pneumonia: a population-based cohort study. Medicine (Baltimore) 2008; 87 (06) 329-334
  • 22 Wesemann T, Nüllmann H, Pflug MA, Heppner HJ, Pientka L, Thiem U. Pneumonia severity, comorbidity and 1-year mortality in predominantly older adults with community-acquired pneumonia: a cohort study. BMC Infect Dis 2015; 15 (01) 2
  • 23 Adamuz J, Viasus D, Jiménez-Martínez E. et al. Incidence, timing and risk factors associated with 1-year mortality after hospitalization for community-acquired pneumonia. J Infect 2014; 68 (06) 534-541
  • 24 Corrales-Medina VF, van Walraven C. Guideline-concordant antibiotic therapy for the hospital treatment of community-acquired pneumonia and 1-year all-cause and cardiovascular mortality in older adult patients surviving to discharge. Chest 2023; 163 (06) 1380-1389
  • 25 Sligl WI, Eurich DT, Marrie TJ, Majumdar SR. Only severely limited, premorbid functional status is associated with short- and long-term mortality in patients with pneumonia who are critically ill: a prospective observational study. Chest 2011; 139 (01) 88-94
  • 26 Mortensen EM, Kapoor WN, Chang CCH, Fine MJ. Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia. Clin Infect Dis 2003; 37 (12) 1617-1624
  • 27 Restrepo MI, Faverio P, Anzueto A. Long-term prognosis in community-acquired pneumonia. Curr Opin Infect Dis 2013; 26 (02) 151-158
  • 28 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
  • 29 Karhu J, Ala-Kokko TI, Ylipalosaari P, Ohtonen P, Laurila JJ, Syrjälä H. Hospital and long-term outcomes of ICU-treated severe community- and hospital-acquired, and ventilator-associated pneumonia patients. Acta Anaesthesiol Scand 2011; 55 (10) 1254-1260
  • 30 Dupuis C, Sabra A, Patrier J. et al. Burden of pneumococcal pneumonia requiring ICU admission in France: 1-year prognosis, resources use, and costs. Crit Care 2021; 25 (01) 24
  • 31 Reyes LF, Garcia E, Ibáñez-Prada ED. et al. Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: a targeted maximum likelihood estimation and survival analysis. Crit Care 2023; 27 (01) 212
  • 32 Cavallazzi R, Furmanek S, Arnold FW. et al. The burden of community-acquired pneumonia requiring admission to ICU in the United States. Chest 2020; 158 (03) 1008-1016
  • 33 Pereira JM, Azevedo A, Basílio C, Sousa-Dias C, Mergulhão P, Paiva JA. Mid-regional proadrenomedullin: an early marker of response in critically ill patients with severe community-acquired pneumonia?. Rev Port Pneumol (2006) 2016; 22 (06) 308-314
  • 34 Pereira JM, Gonçalves-Pereira J, Ribeiro O, Baptista JP, Froes F, Paiva JA. Impact of antibiotic therapy in severe community-acquired pneumonia: data from the Infauci study. J Crit Care 2018; 43: 183-189
  • 35 Meduri GU, Shih MC, Bridges L. et al; ESCAPe Study Group. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med 2022; 48 (08) 1009-1023
  • 36 Yende S, Angus DC, Ali IS. et al. Influence of comorbid conditions on long-term mortality after pneumonia in older people. J Am Geriatr Soc 2007; 55 (04) 518-525
  • 37 Holter JC, Ueland T, Jenum PA. et al. Risk factors for long-term mortality after hospitalization for community-acquired pneumonia: a 5-year prospective follow-up study. PLoS One 2016; 11 (02) e0148741
  • 38 Kaplan V, Clermont G, Griffin MF. et al. Pneumonia: still the old man's friend?. Arch Intern Med 2003; 163 (03) 317-323
  • 39 Kolditz M, Ewig S, Klapdor B. et al; CAPNETZ study group. Community-acquired pneumonia as medical emergency: predictors of early deterioration. Thorax 2015; 70 (06) 551-558
  • 40 Aliberti S, Blasi F, Zanaboni AM. et al. Duration of antibiotic therapy in hospitalised patients with community-acquired pneumonia. Eur Respir J 2010; 36 (01) 128-134
  • 41 Ramirez JA, Musher DM, Evans SE. et al. Treatment of community-acquired pneumonia in immunocompromised adults: a consensus statement regarding initial strategies. Chest 2020; 158 (05) 1896-1911
  • 42 Severiche-Bueno D, Parra-Tanoux D, Reyes LF, Waterer GW. Hot topics and current controversies in community-acquired pneumonia. Breathe (Sheff) 2019; 15 (03) 216-225
  • 43 Emmet O'Brien M, Restrepo MI, Martin-Loeches I. Update on the combination effect of macrolide antibiotics in community-acquired pneumonia. Respir Investig 2015; 53 (05) 201-209
  • 44 Huckle AW, Fairclough LC, Todd I. Prophylactic antibiotic use in COPD and the potential anti-inflammatory activities of antibiotics. Respir Care 2018; 63 (05) 609-619
  • 45 Faverio P, Aliberti S, Bellelli G. et al. The management of community-acquired pneumonia in the elderly. Eur J Intern Med 2014; 25 (04) 312-319
  • 46 Sligl WI, Eurich DT, Marrie TJ, Majumdar SR. Age still matters: prognosticating short- and long-term mortality for critically ill patients with pneumonia. Crit Care Med 2010; 38 (11) 2126-2132
  • 47 Bordon J, Wiemken T, Peyrani P. et al; CAPO Study Group. Decrease in long-term survival for hospitalized patients with community-acquired pneumonia. Chest 2010; 138 (02) 279-283
  • 48 Ramirez J, Aliberti S, Mirsaeidi M. et al. Acute myocardial infarction in hospitalized patients with community-acquired pneumonia. Clin Infect Dis 2008; 47 (02) 182-187
  • 49 Musher DM, Rueda AM, Kaka AS, Mapara SM. The association between pneumococcal pneumonia and acute cardiac events. Clin Infect Dis 2007; 45 (02) 158-165
  • 50 Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012; 125 (06) 773-781
  • 51 Griffin AT, Wiemken TL, Arnold FW. Risk factors for cardiovascular events in hospitalized patients with community-acquired pneumonia. Int J Infect Dis 2013; 17 (12) e1125-e1129
  • 52 Viasus D, Garcia-Vidal C, Manresa F, Dorca J, Gudiol F, Carratalà J. Risk stratification and prognosis of acute cardiac events in hospitalized adults with community-acquired pneumonia. J Infect 2013; 66 (01) 27-33
  • 53 Corrales-Medina VF, Alvarez KN, Weissfeld LA. et al. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA 2015; 313 (03) 264-274
  • 54 Aliberti S, Ramirez JA. Cardiac diseases complicating community-acquired pneumonia. Curr Opin Infect Dis 2014; 27 (03) 295-301
  • 55 Yende S, D'Angelo G, Kellum JA. et al; GenIMS Investigators. Inflammatory markers at hospital discharge predict subsequent mortality after pneumonia and sepsis. Am J Respir Crit Care Med 2008; 177 (11) 1242-1247
  • 56 Mendall MA, Patel P, Asante M. et al. Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Heart 1997; 78 (03) 273-277
  • 57 Kumar A, Thota V, Dee L, Olson J, Uretz E, Parrillo JE. Tumor necrosis factor alpha and interleukin 1beta are responsible for in vitro myocardial cell depression induced by human septic shock serum. J Exp Med 1996; 183 (03) 949-958
  • 58 Corrales-Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis 2010; 10 (02) 83-92
  • 59 Desai A, Aliberti S, Amati F, Stainer A, Voza A. Cardiovascular complications in community-acquired pneumonia. Microorganisms 2022; 10 (11) 2177
  • 60 Reyes LF, Restrepo MI, Hinojosa CA. et al. Severe pneumococcal pneumonia causes acute cardiac toxicity and subsequent cardiac remodeling. Am J Respir Crit Care Med 2017; 196 (05) 609-620
  • 61 Bergh C, Fall K, Udumyan R, Sjöqvist H, Fröbert O, Montgomery S. Severe infections and subsequent delayed cardiovascular disease. Eur J Prev Cardiol 2017; 24 (18) 1958-1966
  • 62 Tralhão A, Póvoa P. Cardiovascular events after community-acquired pneumonia: a global perspective with systematic review and meta-analysis of observational studies. J Clin Med 2020; 9 (02) 414
  • 63 Muzambi R, Bhaskaran K, Brayne C, Davidson JA, Smeeth L, Warren-Gash C. Common bacterial infections and risk of dementia or cognitive decline: a systematic review. J Alzheimers Dis 2020; 76 (04) 1609-1626
  • 64 Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-LOHR V. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 1999; 160 (01) 50-56
  • 65 Jackson JC, Girard TD, Gordon SM. et al. Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial. Am J Respir Crit Care Med 2010; 182 (02) 183-191
  • 66 Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010; 304 (16) 1787-1794
  • 67 Pandharipande PP, Girard TD, Jackson JC. et al; BRAIN-ICU Study Investigators. Long-term cognitive impairment after critical illness. N Engl J Med 2013; 369 (14) 1306-1316
  • 68 van Gool WA, van de Beek D, Eikelenboom P. Systemic infection and delirium: when cytokines and acetylcholine collide. Lancet 2010; 375 (9716): 773-775
  • 69 Rubio-Perez JM, Morillas-Ruiz JM. A review: inflammatory process in Alzheimer's disease, role of cytokines. ScientificWorldJournal 2012; 2012: 756357
  • 70 Sweeney MD, Sagare AP, Zlokovic BV. Blood-brain barrier breakdown in Alzheimer disease and other neurodegenerative disorders. Nat Rev Neurol 2018; 14 (03) 133-150
  • 71 Chalitsios CV, Baskaran V, Harwood RH, Lim WS, McKeever TM. Incidence of cognitive impairment and dementia after hospitalisation for pneumonia: a UK population-based matched cohort study. ERJ Open Res 2023; 9 (03) 00328-02022
  • 72 Aliberti S, Bellelli G, Belotti M. et al. Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia. Aging Clin Exp Res 2015; 27 (04) 523-531
  • 73 Chu CS, Liang CS, Tsai SJ. et al. Bacterial pneumonia and subsequent dementia risk: a nationwide cohort study. Brain Behav Immun 2022; 103: 12-18