Risk of mortality associated with antipsychotic and other neuropsychiatric drugs in pneumonia patients

• Published in: Journal of clinical psychopharmacology Vol. 26; no. 2; p. 182
• Main Authors: Barnett, Mitchell J, Perry, Paul J, Alexander, Bruce, Kaboli, Peter J
• Format: Journal Article
• Language: English
• Published: United States 01.04.2006
• Subjects: Aged; Antidepressive Agents, Tricyclic - adverse effects; Antidepressive Agents, Tricyclic - therapeutic use; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Cohort Studies; Female; Health Services for the Aged; Hospital Mortality; Humans; Length of Stay; Male; Pneumonia - drug therapy; Pneumonia - mortality; Risk Factors; Survival Analysis; Tranquilizing Agents - adverse effects; Tranquilizing Agents - therapeutic use; United States; United States Department of Veterans Affairs; United States
• ISSN: 0271-0749
• DOI: 10.1097/01.jcp.0000203598.43314.34

To evaluate the use of typical and atypical antipsychotic medications and associated in-hospital mortality in a group of Veterans Administration (VA) patients with pneumonia. Our cohort consisted of 14,057 VA patients admitted for pneumonia in fiscal year (FY) 2003. Exposure to typical and atypical antipsychotics and other neuropsychiatric drugs was based on a prescription within 120 days preceding admission. Multivariate models determined the odds of mortality associated with each drug class and risk adjusted for comorbidity, admission source, demographic factors, and concurrent mental health conditions. The referent group for each analysis was pneumonia patients not receiving neuropsychiatric drugs. In adjusted analyses, the odds of in-hospital mortality for VA patients admitted with pneumonia was higher for recent exposure to typical antipsychotics (OR = 1.51, 95% CI = 1.04-2.19; P = 0.03) when compared to patients not receiving neuropsychiatric medications. Patients exposed to atypical antipsychotics (OR = 1.20, 95% CI = 0.96-1.50, P = .10), tricyclic antidepressants (OR = 1.20, 95% CI = 0.44-1.55; P = 0.15), other antidepressants (OR = 1.07, 95% CI = 0.93-1.23; P = 0.37), or mood stabilizers (OR = 0.91, 95% CI = 0.73-1.14; P = 0.41) had no significant difference in in-hospital mortality. In spite of recent safety concerns for atypical antipsychotics, we found no increased risk of mortality in acutely ill pneumonia patients. Rather, we found a higher adjusted mortality rate for patients taking typical antipsychotics. The contrasting mortality risks for patients taking typical and atypical antipsychotics may represent unmeasured severity of illness or comorbidity. Regardless, any antipsychotics should be used with caution and the efficacy and safety of alternative agents should be considered.