P12 Risk factors influencing mortality and morbidity in community-acquired pneumonia: a multivariable analysis

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Introduction Community-acquired pneumonia (CAP) significantly impacts morbidity and mortality. Identifying risk factors is crucial for improving patient outcomes. This study evaluates the effects of demographic characteristics, comorbidities, and clinical parameters on all-cause mortality and morbidity in radiologically confirmed CAP, aiming to inform targeted interventions and enhance strategies to reduce CAP-related complications. Methods All hospitalized and ambulatory adult patients with radiologically confirmed pneumonia referred for outpatient follow-up clinic at a tertiary hospital between May 2023 and November 2023 were reviewed. Demographics, inhaled and oral steroid use, Charlson comorbidity index (CCI), CURB-65 score, white cell count (WCC), and C-reactive protein (CRP), and any readmission or deaths were collected. Results were analysed with a cox proportional-hazards model. Results 221 patients were identified. Mean age at diagnosis was 65.9 (range: 27 to 97). Use of either inhaled corticosteroids (ICS) or oral corticosteroids was shown to be associated with a significantly lower admission free survival compared to no steroid use (p<0.001, p =0.003). This association remains significant in the multivariable analysis (p =0.032, p=0.020). However, the combination of oral and ICS does not show a significant association with readmission free survival in the multivariable analysis (HR 0.99, p=0.979). Both ex-smokers and current smokers showed a strong and significant association with increased risk of readmission compared to never smokers (p = 0.006, p < 0.001), even after adjusting for other factors, with smokers being at the highest risk. Log-transformed CRP levels were also found to be associated with a decreased risk of readmission, suggesting an inverse relationship. Factors like gender, CCI, CURB-65, and WCC did not show significant associations in the multivariable model, suggesting their effects are explained by other variables in the model. Conclusions Use of inhaled or oral corticosteroids significantly reduces admission-free survival in adult CAP patients, though their use in combination did not appear to have additional impact. . The higher readmission risk of current and ex-smokers gives more evidence towards the importance of implementing risk-reducing strategies during and after admission to hospital. The inverse relationship between CRP and readmission rate may suggest that stronger immune response may be beneficial.

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