Creutz P, Kothe H, Braun M, Bauer T, Suttorp N, Welte T, Dalhoff K and the CAPNETZ study group
Background: Outpatient treatment is an increasingly used option in Community-Acquired Pneumonia (CAP). Risk factors for deterioration and subsequent hospitalization are poorly characterized.
Material and Methods: A prospective study was conducted to assess risk factors associated with hospitalization of CAP-patients initially treated in an outpatient setting. Clinical history, severity of disease, physical examination findings, laboratory test results, initial treatment and outcome were prospectively documented in both groups. Data derived from a multicenter prospective study initiated by the German competence network for communityacquired pneumonia CAPNETZ. The network includes 10 clinical centers representing hospital and outpatient facilities from all levels of health care. 5431 patients with CAP were screened for inclusion. 1517 of these patients were initially treated as outpatients and included. 1403 patients were treated exclusively in an outpatient setting, 114 (8.1%) were hospitalized after initial outpatient treatment.
Results: Compared to patients treated exclusively in an outpatient setting patients with subsequent hospitalization had a significantly higher 28-day mortality rate (4.2% vs. 0.2%, p=<0.001), advanced mean age (56.7 vs. 50.9 years, p=<0.05), and a higher CRB-65 score. However 53.3% of subsequently admitted patients had CRB-65=0, and 23% had CRB-65=1 with age >65 years as the only risk factor. Cerebrovascular disease, chronic kidney disease and diabetes mellitus were overrepresented in this patient group. In addition, cephalosporin monotherapy was identified as independent risk factor for hospitalization.
Conclusion: In ambulatory CAP patients subsequent hospitalization was observed mainly in low CRB-65 risk classes and was associated with comorbidities and the choice of initial therapy
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