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VOLUME 62 , ISSUE 3 ( July-September, 2020 ) > List of Articles

Original Article

Aetiology, Clinical Presentation and Outcome in Patients with Community-Acquired Pneumonia Requiring Hospitalisation: A Prospective Study

J. Harikrishna, Vasili Pradeep, Alladi Mohan, K.M. Bhargav, Abhijit Chaudhury, B. Vijayalakshmi Devi, K.V.S. Sarma

Keywords : Community acquired pneumonia, India, Aetiology, APACHE II score, Pneumonia severity index, Outcome

Citation Information : Harikrishna J, Pradeep V, Mohan A, Bhargav K, Chaudhury A, Devi BV, Sarma K. Aetiology, Clinical Presentation and Outcome in Patients with Community-Acquired Pneumonia Requiring Hospitalisation: A Prospective Study. Indian J Chest Dis Allied Sci 2020; 62 (3):117-125.

DOI: 10.5005/ijcdas-62-3-117

License: NA

Published Online: 07-09-2020

Copyright Statement:  NA


Abstract

Background: There is paucity of reliable published data from Andhra Pradesh, India regarding aetiology, clinical presentation and outcome in patients with community-acquired pneumonia (CAP) requiring hospitalisation. Methods: We prospectively studied 100 consecutive adult patients admitted with CAP during the period January 2018 to June 2019 at our tertiary care teaching hospital in Tirupati, Andhra Pradesh, South India. Results: Their mean age was 54.4±15.7 years; there were 57 (57%) males. Single aetiology was found in 42% with influenza A (H1N1)pdm09 (12%), Legionella pneumophila (9%) being the most common; more than one concurrent aetiological agents were found in 31%; and no aetiological agent could be established in 27% patients. Mechanical ventilation (both noninvasive ventilation [NIV] and invasive mechanical ventilation [IMV]) were required in 65 patients. NIV was required in 58 patients, of them 38 had recovered; 20 had NIV-failure and required tracheal intubation and IMV. Sixteen patients died; 12 due to CAP and the rest due to other causes. On receiver-operator characteristic (ROC)-curve analysis acute physiology and chronic health evaluation II (APACHE II) score ≤14 (sensitivity 84.5% and specificity 56.3%), pneumonia severity index (PSI) score ≤98 (sensitivity 72.6% and specificity 68.8%) and erythrocyte sedimentation rate (ESR) ≤76 (sensitivity 73.8% and specificity 62.5%) were predictors of death. On multivariable analysis need for IMV (p<0.001) emerged as an independent predictor of death. Conclusions: CAP can present with single or multiple concurrent aetiologies. A trial of NIV can obviate the need for IMV. On multivariable analysis, need for IMV is an independent predictor of death in patients with CAP.

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