Background Community acquired pneumonia (CAP) is a common cause of hospital admissions and carries a high mortality rate. Risk stratification through clinical assessment, underlying chronic lung disease, SIRS and CURB65 helps identify patients at moderate to high risk of mortality. Despite prompt and appropriate management, a significant number of patients (18.3%) die in hospital (BTS Adult CAP audit 2009/10).
Aims and objectives We wished to determine our hospital’s CAP mortality rate and ascertain the proportion of patients with a high likelihood of death, as predicted by high CURB-65 scores, markers of severe infection (SIRS criteria) and underlying chronic respiratory disease.
Methods Case notes of all patients admitted with CAP over a 3 month period were requested and 175 were obtained. Information was gathered on the presence of underlying chronic lung conditions, CAP severity/mortality markers (SIRS and CURB65 scores) and mortality.
Results At least one underlying chronic pulmonary condition was found in 45.1% (n = 79), the commonest being COPD (n = 56). CURB65 score was 0 to 1 in 39.4% (low risk), 2 in 27.4% (moderate risk), 3–5 in 17.2% (high risk) and not done in 16% (n = 28). SIRS criteria were met in just under half of the cases (48.5% n = 85).
An in-patient mortality review during this study period showed that 8% (n = 14) CAP patients died in hospital within 30 days. An association of these patients with background lung condition, CURB65 and SIRS is shown in Table 1.
Conclusion We showed an improvement in mortality figures compared with the BTS National CAP adult audit 5 years ago (8% vs 18.3%). A significant number of these patients have an underlying chronic lung disease which predisposed them to developing CAP. The highest mortality was seen in patients with a high CURB65 score with SIRS response.