Prognosis

Severe community-acquired pneumonia (CAP) often leads to long term complications. Cardiovascular events and neurologic impairment, due to persistent inflammation and hypoxemia, contribute to outcomes in CAP, including mortality. 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.[200][201]

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.[37][202]

Several risk factors, such as bacteremia, intensive care unit admission, comorbidities (especially neurologic disease), and infection with a potentially multidrug-resistant pathogen (e.g., Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacteriaceae), are associated with increased 30-day mortality.[42][203][204][205]

Readmission rates in patients with CAP range from 7% to 12%.[206][207] In most cases, exacerbation of comorbidities (mainly cardiovascular, pulmonary, or neurologic disease) is responsible for readmission.

Approximately one third of hospitalized patients die within a year of being discharged from the hospital, with cardiac events accounting for more than 30% of deaths in CAP patients.[208]

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.[209] 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. One 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.[210]

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