Mortality and costs of pneumococcal pneumonia in adults: a cross-sectional study

Michelin, Lessandra; Weber, Fernanda M.; Scolari, Bruna W.; Menezes, Bruna K.; Gullo, Maria Carolina

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Brasil

Jornal Brasileiro de Pneumologia

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Brasil

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Sumário

ORIGINAL ARTICLE • J. Bras. Pneumol. 45 (6) • 2019 • https://doi.org/10.1590/1806-3713/e20180374 copy

Mortality and costs of pneumococcal pneumonia in adults: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

Pneumococcal pneumonia is a significant cause of morbidity and mortality among adults. The study’s main aim was to evaluate the in-hospital mortality and related costs of community-acquired pneumococcal pneumonia in adults.

Methods

This cross-sectional study used medical records of adult patients with pneumococcal pneumonia hospitalized in a university hospital in Brazil from October 2009 to April 2017. All patients aged ≥ 18 years diagnosed with pneumococcal pneumonia were included. Risk factors, intensive care unit admission, length of hospital stay, in-hospital mortality, and direct and indirect costs were analyzed.

Results

In total, 186 patients were selected. The mean in-hospital mortality rate was 18% for adults aged < 65 years and 23% for the elderly (≥ 65 years). Bacteremic pneumococcal pneumonia affected 20% of patients in both groups, mainly through chronic respiratory disease (adjusted OR: 3.07, 95% CI: 1.23–7.65, p < 0.01). Over 7 years, annual total direct and indirect costs were USD 28,188 for adults < 65 years (USD 1,746 per capita) and USD 16,350 for the elderly (USD 2,119 per capita).

Conclusion

Pneumococcal pneumonia remains an important cause of morbidity and mortality among adults, significantly affecting direct and indirect costs. These results suggest the need for prevention strategies for all adults, especially for patients with chronic respiratory diseases.

Keywords:
Pneumococcus; Pneumococcal disease; Pneumonia; Hospital costs; Mortality

Characteristic	Age < 65 years	Age ≥ 65 years	P value
Characteristic	(n = 127)	(n = 59)	P value
Male, n (%)	78 (62.4)	40 (67.8)	0.40
Age (in years), mean (SD)	46 (36–55)	70 (67–72)	0.001
Average income, n (%)
Dependent	38 (30)	17 (29)	0.30
Low	80 (63)	42 (71)
Average	9 (7)	0 (0)
High	0 (0)	0 (0)
Pneumonia, n (%)
Pneumococcal pneumonia	102 (80)	48 (81)	0.86
Bacteremic pneumococcal pneumonia	25 (20)	11 (19)	0.86
Comorbidities, n (%)
Chronic heart disease	36 (28.3)	31 (52.5)	< 0.01
Chronic respiratory disease	47 (37.0)	35 (59.3)	< 0.01
Chronic liver disease	11 (8.6)	0 (0)	< 0.01
Chronic renal disease	11 (8.6)	3 (5.0)	< 0.01
HIV	29 (22.8)	0 (0)	< 0.01
Chronic neurological disease	8 (6.3)	5 (8.5)	0.60
Immunosuppression	19 (14.9)	17 (28.8)	0.02
Diabetes mellitus	6 (4.7)	4 (6.7)	0.50
Smoking	46 (36.2)	24 (40.6)	0.60
Alcohol abuse	25 (19.7)	10 (16.9)	0.60
ICU admission, n (%)	33 (25.6)	17 (28.8)	0.10
Mean length of stay (days)
Total	10 (7–15)	14 (5–22)	0.46
ICU	3 (0–5)	2 (0–3)	0.40
Death, n (%)	23 (18.1)	14 (23.7)	0.34

Risk factor	OR	95% CI	P value
Aged ≥ 65 years	1.41	0.66–2.98	0.40
Chronic respiratory disease	0.40	0.18–0.88	0.02
Chronic heart disease	1.10	0.52–2.32	0.80
Chronic liver disease	1.56	0.39–6.20	0.50
Chronic renal disease	2.43	0.76–7.74	0.15
HIV	0.60	0.20–1.85	0.35
Chronic neurological disease	1.89	0.55–6.50	0.31
Immunosuppression	0.97	0.39–2.52	0.94
Smoking	1.17	0.56–2.43	0.70
Alcohol abuse	1.52	0.60–3.60	0.35
Diabetes mellitus	0.43	0.05–3.52	0.40
Bacteremic pneumonia	0.57	0.25–1.32	0.20
ICU mortality	156.3	34.1–715.9	< 0.001

Risk factor	Adjusted OR	95% CI	P value
Aged ≥ 65 years	0.77	0.32–1.90	0.58
Chronic respiratory disease	3.07	1.23–7.65	0.01
Chronic heart disease	0.88	0.36–2.16	0.77
Chronic liver disease	0.76	0.16–3.23	0.68
HIV	1.16	0.37–3.64	0.80
Chronic neurological disease	1.87	0.35–9.89	0.43
Immunosuppression	2.55	0.80–8.18	0.09
Diabetes mellitus	0.60	0.13–2.81	0.53

Costs	Aged < 65 years	Aged ≥ 65 years
Direct costs per capita	USD 1,515	USD 1,902
Indirect costs per capita	USD 231	USD 216
Total cost per capita	USD 1,746	USD 2,119
Total annual cost	USD 28,188	USD 16,350

Sociedade Brasileira de Pneumologia e Tisiologia SCS Quadra 1, Bl. K salas 203/204, 70398-900 - Brasília - DF - Brasil, Fone/Fax: 0800 61 6218 ramal 211, (55 61)3245-1030/6218 ramal 211 - São Paulo - SP - Brazil
E-mail: jbp@sbpt.org.br

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[1] *Lessandra Michelin. Diretoria Hospital Geral, Universidade de Caxias do Sul, Rua Prof Antonio Vignolli, 255, CEP 95070-561, Caxias do Sul, RS, Brasil. Tel.: +55 54 9 9163-6437. E-mail: lessandra@gmail.com