Predictors of Mortality Among U.S. Veterans With Streptococcus Pneumoniae Infections

• Published in: American journal of preventive medicine Vol. 52; no. 6; pp. 769 - 777
• Main Authors: Morton, Jacob B., PharmD, MBA, BCPS, Morrill, Haley J., PharmD, LaPlante, Kerry L., PharmD, FCCP, Caffrey, Aisling R., PhD, MS
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.06.2017; Elsevier Science Ltd
• Subjects: Adults; Aged; Blood; Case-Control Studies; Cerebrospinal fluid; Comorbidity; Dementia; Dialysis; Female; Hospitalization; Humans; Immune system; Immunization; Infections; Internal Medicine; Invasive; Liver; Liver diseases; Male; Medical history; Meningitis; Mortality; Neutropenia; Pneumococcal disease; Pneumococcal Infections - mortality; Pneumonia; Risk Assessment; Streptococcus infections; Veterans; Veterans - statistics & numerical data
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2016.10.023

Introduction Serious Streptococcus pneumoniae infections, encompassing pneumonia, bacteremia, and meningitis, are a major cause of mortality. However, literature regarding mortality is often limited to invasive pneumococcal disease, excluding pneumonia. This study sought to identify predictors of mortality among adults with serious pneumococcal disease, including pneumonia and invasive pneumococcal disease. Methods This was a nested case-control study of unvaccinated older Veterans with positive S. pneumoniae cultures (blood, cerebrospinal fluid, respiratory) admitted to Veterans Affairs medical centers nationally between 2002 and 2011. Patients vaccinated against pneumococcal disease were excluded. Using multivariable logistic regression, predictors of 30-day mortality were identified, including patient demographics, comorbidities during admission, and medical history within the previous year. Results Among 9,468 patients, there were 9,730 serious pneumococcal infections; 1,764 (18.6%) resulted in death within 30 days (cases), whereas 7,966 did not (controls). Pneumonia accounted for half (49.4%, n =871) of all deaths. Mortality predictors consistent with vaccine recommendations included dialysis (during hospitalization, OR=3.35, 95% CI=2.37, 4.72), moderate to severe liver disease (during hospitalization, OR=2.47, 95% CI=1.53, 3.99; within 1 year, OR=1.49, 95% CI=1.01, 2.20), and neutropenia (during hospitalization, OR=2.67, 95% CI=1.32, 5.42). Predictors not included in current recommendations included dementia (during hospitalization, OR=1.8, 95% CI=1.23, 2.61) and neurologic disorders (during hospitalization, OR=1.86, 95% CI=1.42, 2.45; within 1 year, OR=1.28, 95% CI=1.02, 1.59). Conclusions Several mortality predictors among unvaccinated Veterans with serious pneumococcal disease were consistent with pneumococcal vaccine recommendations, including organ or immune system dysfunction–related conditions. Other predictors, including neurologic disorders or dementia, may warrant expanded vaccination recommendations.