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Prognosis

• Outpatients
  
  • Young, otherwise healthy adults
    • Those treated as outpatients usually feel well enough to return to work in 4 or 5 days; almost all recover in 2 weeks.
    • Those with relatively severe symptoms may require longer to recover.
  • ~2–4% of those treated as outpatients experience a progression of symptoms and require hospital admission.
• Inpatients
  
  • Patients generally stabilize within 3–7 days.
  • The in-hospital mortality rate from pneumonia is ~8%.
    • The most common immediate causes of death are respiratory failure, heart disease, and sepsis.
    • ~50% of deaths are related to pneumonia and ~50% to comorbid illnesses.
    • Pneumonia-related deaths are much more likely to occur during the first week of hospitalization.
    • Increasing age and evidence of aspiration independently predict both pneumonia-related and comorbidity-related mortality.
  • Factors independently associated with pneumonia-unrelated mortality include:
    • Dementia
    • Immunosuppression
    • Active cancer
    • Systolic hypotension
    • Male gender
    • Multilobar pulmonary infiltrates
  • Mortality associated with PORT score (see Treatment Approach)
    
  • Class I: 0–0.5%
  • Class II: 0.4–0.9%
  • Class III: 0–1.25%
  • Class IV: 9.0–12.5%
  • Class V: 27.1%
• Mortality is related to the specific etiology.
  • Rates are highest (>50%) for P. aeruginosa, followed by Klebsiella spp., E. coli, S. aureus, and Acinetobacter spp. (all 30–35%).
  • Pneumococcal capsular serotype 3 is associated with a much higher mortality rate than serotype 1, as are group A streptococcal M serotypes 1 and 3 (compared with other serotypes).
• Early, appropriate antibiotic therapy is associated with decreased mortality rates.
  

The Harrison's Practice Preview allows you to view 5 FREE complete topics or conduct a search that delivers abstracts for more than 450 medical topics. For full access, please subscribe today!