Comparison of clinical outcomes in hospitalized patients with COVID-19 or non-COVID-19 community-acquired pneumonia in a prospective observational cohort study

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2024年5月18日

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Hans-Jakob Meyer,
Lukas Mödl,
Olesya Unruh,
Weiwei Xiang,
Sarah Berger,
Moritz Müller-Plathe,
Gernot Rohde,
Mathias W. Pletz,
Jan Rupp,
Norbert Suttorp,
Martin Witzenrath,
Thomas Zoller,
Mirja Mittermaier,
Fridolin Steinbeis,
A Fuchs,
M Engelmann,
D Stolz,
W Bauer,
H. C Mücke,
S Schmager,
B Schaaf,
J Kremling,
D Nickoleit-Bitzenberger,
H Azzaui,
M Hower,
F Hempel,
K Prebeg,
K Popkirova,
M Kolditz,
C Bellinghausen,
A Grünewaldt,
M Panning,
T Welte,
T Fühner,
M. van’t Klooster,
G Barten-Neiner,
W Kröner,
N Adaskina,
F Eberherdt,
C Julius,
T Illig,
N Klopp,
B. T Schleenvoigt,
C Forstner,
A Moeser,
J Ankert,
D Drömann,
P Parschke,
K Franzen,
N Käding,
F Waldeck,
C Spinner,
J Erber,
F Voit,
J Schneider,
D Heigener,
I Hering,
W Albrich,
M Seneghini,
F Rassouli,
S Baldesberger,
A Essig,
S Stenger,
M Wallner,
H Burgmann,
L Traby,
L Schubert,
R Chen

摘要

Purpose

Coronavirus disease 2019 (COVID-19) and non-COVID-19 community-acquired pneumonia (NC-CAP) often result in hospitalization with considerable risks of mortality, ICU treatment, and long-term morbidity. A comparative analysis of clinical outcomes in COVID-19 CAP (C-CAP) and NC-CAP may improve clinical management.

Methods

Using prospectively collected CAPNETZ study data (January 2017 to June 2021, 35 study centers), we conducted a comprehensive analysis of clinical outcomes including in-hospital death, ICU treatment, length of hospital stay (LOHS), 180-day survival, and post-discharge re-hospitalization rate. Logistic regression models were used to examine group differences between C-CAP and NC-CAP patients and associations with patient demography, recruitment period, comorbidity, and treatment.

Results

Among 1368 patients (C-CAP: n = 344; NC-CAP: n = 1024), C-CAP showed elevated adjusted probabilities for in-hospital death (aOR 4.48 [95% CI 2.38–8.53]) and ICU treatment (aOR 8.08 [95% CI 5.31–12.52]) compared to NC-CAP. C-CAP patients were at increased risk of LOHS over seven days (aOR 1.88 [95% CI 1.47–2.42]). Although ICU patients had similar in-hospital mortality risk, C-CAP was associated with length of ICU stay over seven days (aOR 3.59 [95% CI 1.65–8.38]). Recruitment period influenced outcomes in C-CAP but not in NC-CAP. During follow-up, C-CAP was linked to a reduced risk of re-hospitalization and mortality post-discharge (aOR 0.43 [95% CI 0.27–0.70]).

Conclusion

Distinct clinical trajectories of C-CAP and NC-CAP underscore the need for adapted management to avoid acute and long-term morbidity and mortality amid the evolving landscape of CAP pathogens.