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The Roles of the Charlson Comorbidity Index and Time to First Antibiotic Dose as Predictors of Outcome in Pneumococcal Community-Acquired Pneumonia

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Abstract

Purpose

In this retrospective study, we aimed to investigate the role of comorbidities using the Charlson comorbidity index (CCI) and time to first antibiotic dose (TFAD) in patients with pneumococcal community-acquired pneumonia (PCAP).

Methods

All consecutive ER admissions with PCAP who were hospitalized in the University Hospital, Zurich between 2006 and 2012 were included. The primary outcome was to determine possible determinants of all-cause in-hospital mortality (ACIHM). The second endpoint was to detect risk factors for adverse events (AEs) and determinants of length of stay (LOS).

Results

108 subjects (mean age 57.6 years) were included. The median (IQR) CCI was 4 (1, 8). The median (IQR) TFAD was 210 (150, 280) min. ACIHM was 6.5 % (7/108), and median (IQR) LOS was 9 (6, 14) days. PCAP-related AEs were observed in 57 cases (52.8 %). In the multivariable analysis, neither CCI nor TFAD was associated with the outcome measures. Pneumonia severity index (PSI) was the only statistically significant predictor of ACIHM (HR 1.31/10 point increase, 95 % CI 1.12–1.53, p = 0.001) and AE rate (OR 1.31, 95 % CI 1.15–1.50, p < 0.001).

Conclusions

In this study including comparatively young patients with rather mild disease severity, we found no strong evidence supporting that CCI or TFAD influenced short-term outcome measures of PCAP. Yet, pneumonia severity appears to be the most important factor for the outcome.

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Acknowledgments

We thank Prof Reinhard Zbinden (Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland) for providing serotyping of all S. pneumoniae.

Authors’ Contributions

DF, SPK and MK conceived of the study, and participated in its design and coordination. ML carried out data acquisition and wrote the manuscript. DJB participated in the design of the study and performed the statistical analysis. All authors read and approved the final manuscript.

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    Authors and Affiliations

    1. Department of Pulmonology, University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

      Daniel Franzen, Marisa Lim, Daniel J. Bratton & Malcolm Kohler

    2. Department of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

      Stefan P. Kuster

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    1. Daniel Franzen
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    2. Marisa Lim
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    Correspondence to Daniel Franzen.

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    On behalf of all authors, the corresponding author states that there is no conflict of interest.

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    Daniel Franzen and Marisa Lim authors contributed equally to this article.

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    Franzen, D., Lim, M., Bratton, D.J. et al. The Roles of the Charlson Comorbidity Index and Time to First Antibiotic Dose as Predictors of Outcome in Pneumococcal Community-Acquired Pneumonia. Lung 194, 769–775 (2016). https://doi.org/10.1007/s00408-016-9922-z

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    • DOI: https://doi.org/10.1007/s00408-016-9922-z

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