Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.

<h4>Background</h4>Invasive pneumococcal disease continues to be an important cause of mortality. In Calgary, 60% of deaths occur within 5 days of presenting to hospital. This proportion has not changed since before the era of penicillin. The purpose of this study was to investigate what...

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Autores principales:	Leah J Ricketson, Alberto Nettel-Aguirre, Otto G Vanderkooi, Kevin B Laupland, James D Kellner
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d118a906639c4cf5b951710f13754f24
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spelling	oai:doaj.org-article:d118a906639c4cf5b951710f13754f242021-11-18T08:51:56ZFactors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.1932-620310.1371/journal.pone.0071924https://doaj.org/article/d118a906639c4cf5b951710f13754f242013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24115997/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Invasive pneumococcal disease continues to be an important cause of mortality. In Calgary, 60% of deaths occur within 5 days of presenting to hospital. This proportion has not changed since before the era of penicillin. The purpose of this study was to investigate what factors may influence death within 5 days of presentation with pneumococcal disease.<h4>Methods and findings</h4>Demographic and clinical data from the CASPER (Calgary Area Streptococcus pneumoniae Epidemiology Research) study on 1065 episodes of invasive pneumococcal disease in adults (≥18 years) from 2000 to 2010 were analyzed. Adjusted multinomial regression was performed to analyze 3 outcomes: early mortality (<5 days post-presentation), late mortality (5-30 days post-presentation), and survival, generating relative risk ratios (RRR). Patients with severe disease had increased risk of early and late death. In multinomial regression with survivors as baseline, the risk of early death increased in those with a Charlson index ≥2 (RRR: 6.3, 95% CI: 1.8-21.9); the risk of late death increased in those with less severe disease and a Charlson ≥2 (RRR: 6.1, 95% CI: 1.4-27.7). Patients who never received appropriate antibiotics had 5.6X (95% CI: 2.4-13.1) the risk of early death. Risk of both early and late death increased by a RRR of 1.3 (95% CI: 1.2-1.4) per 5-year increase in age. In multinomial regression, there were no significant differences in the effects of the factors tested between early and late mortality.<h4>Conclusions</h4>Presenting with severe invasive pneumococcal disease, multiple comorbidities, and older age increases the risk of both early and late death. Patients who died early often presented too late for effective antibiotic therapy, highlighting the need for an effective vaccine.Leah J RicketsonAlberto Nettel-AguirreOtto G VanderkooiKevin B LauplandJames D KellnerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 10, p e71924 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Leah J Ricketson Alberto Nettel-Aguirre Otto G Vanderkooi Kevin B Laupland James D Kellner Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.
description	<h4>Background</h4>Invasive pneumococcal disease continues to be an important cause of mortality. In Calgary, 60% of deaths occur within 5 days of presenting to hospital. This proportion has not changed since before the era of penicillin. The purpose of this study was to investigate what factors may influence death within 5 days of presentation with pneumococcal disease.<h4>Methods and findings</h4>Demographic and clinical data from the CASPER (Calgary Area Streptococcus pneumoniae Epidemiology Research) study on 1065 episodes of invasive pneumococcal disease in adults (≥18 years) from 2000 to 2010 were analyzed. Adjusted multinomial regression was performed to analyze 3 outcomes: early mortality (<5 days post-presentation), late mortality (5-30 days post-presentation), and survival, generating relative risk ratios (RRR). Patients with severe disease had increased risk of early and late death. In multinomial regression with survivors as baseline, the risk of early death increased in those with a Charlson index ≥2 (RRR: 6.3, 95% CI: 1.8-21.9); the risk of late death increased in those with less severe disease and a Charlson ≥2 (RRR: 6.1, 95% CI: 1.4-27.7). Patients who never received appropriate antibiotics had 5.6X (95% CI: 2.4-13.1) the risk of early death. Risk of both early and late death increased by a RRR of 1.3 (95% CI: 1.2-1.4) per 5-year increase in age. In multinomial regression, there were no significant differences in the effects of the factors tested between early and late mortality.<h4>Conclusions</h4>Presenting with severe invasive pneumococcal disease, multiple comorbidities, and older age increases the risk of both early and late death. Patients who died early often presented too late for effective antibiotic therapy, highlighting the need for an effective vaccine.
format	article
author	Leah J Ricketson Alberto Nettel-Aguirre Otto G Vanderkooi Kevin B Laupland James D Kellner
author_facet	Leah J Ricketson Alberto Nettel-Aguirre Otto G Vanderkooi Kevin B Laupland James D Kellner
author_sort	Leah J Ricketson
title	Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.
title_short	Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.
title_full	Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.
title_fullStr	Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.
title_full_unstemmed	Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.
title_sort	factors influencing early and late mortality in adults with invasive pneumococcal disease in calgary, canada: a prospective surveillance study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/d118a906639c4cf5b951710f13754f24
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Factors influencing early and late mortality in adults with invasive pneumococcal disease in Calgary, Canada: a prospective surveillance study.

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