Prognosis

Prognosis is determined by 3 major factors: age of the patient, general state of health (presence of comorbidities), and the setting where antibiotic treatment is given. In general, the mortality rate in outpatients is <1%, while for hospitalized patients, mortality rate ranges from 5% to 15%, but increases to between 20% and 50% in patients requiring intensive care unit admission.[31][151]

Several risk factors, such as bacteremia, intensive care unit admission, comorbidities (especially neurological disease), and infection with a potentially multidrug-resistant pathogen (e.g., Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacteriaceae), are associated with increased 30-day mortality.[36][152][153][154]

Readmission rates in patients with CAP range from 7% to 12%.[155][156] In most cases, exacerbation of comorbidities (mainly cardiovascular, pulmonary, or neurological disease) is responsible for readmission.

Prognostic biomarkers such as pro-adrenomedullin, prohormone forms of atrial natriuretic peptide, cortisol, procalcitonin, and C-reactive protein are being studied as predictors of mortality; however, further studies are required before these biomarkers are used for this function in clinical practice.[157] A new screening tool, the quick Sequential Organ Failure Assessment (qSOFA), has been used to identify patients with infections who are at high risk of death. A meta-analysis found that a qSOFA score of 2 or greater has been strongly associated with mortality in patients with pneumonia; however, this score has poor sensitivity and further studies are required.[158]

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