Does prolonged onset of symptoms have a prognostic significance in community-acquired pneumonia?

• Published in: Respirology (Carlton, Vic.) Vol. 19; no. 7; pp. 1073 - 1079
• Main Authors: Sanz, Francisco, Restrepo, Marcos I., Fernández-Fabrellas, Estrella, Cervera, Ángela, Briones, María Luisa, Novella, Laura, Aguar, María Carmen, Chiner, Eusebi, Fernandez, Juan F., Blanquer, José
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-10-2014
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; antibiotic; Cohort Studies; Community-Acquired Infections; community-acquired pneumonia; complication; Delayed Diagnosis; Female; Gram-Negative Bacterial Infections - complications; Gram-Negative Bacterial Infections - diagnosis; Gram-Negative Bacterial Infections - therapy; Gram-Positive Bacterial Infections - complications; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - therapy; Hospitalization; Humans; Legionella pneumophila; Male; Middle Aged; Mycoplasma pneumoniae; outcome; Pneumonia, Bacterial - complications; Pneumonia, Bacterial - diagnosis; Pneumonia, Bacterial - therapy; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Pneumonia, Viral - therapy; Prognosis; risk factor; Spain; Streptococcus pneumoniae; Time-to-Treatment; Spain; antibiotic; complication; community-acquired pneumonia; risk factor; outcome
• DOI: 10.1111/resp.12346
• EISSN: 1440-1843
• ISSN: 1323-7799

Background and objective
Severity assessment is made at the time of the initial clinical presentation in patients with community‐acquired pneumonia (CAP). It is unclear how the gap between time of presentation and duration of symptoms onset may impact clinical outcomes. Here we evaluate the association of prolonged onset of symptoms (POS) and the impact on clinical outcomes among hospitalized patients with CAP.
Methods
This was a prospective, multicentre study of CAP in Spain. The primary outcomes were the clinical factors associated with POS defined as days from symptoms onset to pneumonia diagnosis >7 days. The secondary outcomes were intensive care unit (ICU) admission, the presence of suppurative complications, septic shock and 30‐day mortality.
Results
We enrolled 1038 patients diagnosed of CAP: 152 (14.6%) patients had a POS. In multivariate analysis, the presence of prior corticosteroid therapy, alcohol abuse, prior antibiotic therapy, and confusion, urea, respiratory rate, blood pressure and age 65 years or older score 0–1 was independently associated with POS. Patients with POS had a higher incidence of suppurative complications, but not of 30‐day mortality when compared with a shorter onset of symptoms.
Conclusions
Approximately 15% of patients diagnosed with CAP had POS. Risk factors associated with POS were previous corticosteroids and antibiotic therapy, alcoholism and less severe pneumonia. POS was associated with a higher rate of suppurative complications and less need for ICU admission.
Onset of symptoms for more than 7 days is found in nearly 15% of patients with CAP. Prior corticosteroid therapy, antibiotic therapy, alcohol abuse and CURB‐65 score 0–1 were independently associated with prolonged symptoms onset. Those patients had a higher incidence of suppurative complications, but not of 30‐day mortality.