CHEST
Original Research: Chest InfectionsTobacco Smoking Increases the Risk for Death From Pneumococcal Pneumonia
Section snippets
Design and Study Population
The current study is a secondary analysis, and the whole prospective cohort has been published.28 In brief, inclusion criteria were adults aged > 18 years with a new radiographic infiltrate compatible with the presence of acute pneumonia and at least two signs or symptoms of CAP. Exclusion criteria were admission within the previous 15 days, solid organ transplantation, hematologic malignancies, immunosuppressive treatment and/or chronic corticosteroid treatment (≥ 20 mg/d), and HIV infection.
General Characteristics
We recruited 4,374 patients with CAP in the whole cohort study; 86 were excluded due to missing data. A total of 913 patients had pneumococcal CAP (21.3%), of whom 83 had mixed etiology (pneumococcus-involved mixed etiology) and 21 lost to follow-up were excluded. The study group comprised 892 patients with pneumococcal CAP (Table 1). Main patient characteristics, habits, vaccination status, comorbid conditions, sepsis status, and CURB-65 score are shown in Table 2. Of these patients, 204 were
Discussion
The main findings of our study are the following:
Current smokers developed sepsis and require hospitalization for pneumococcal CAP at a younger age than noncurrent smokers.
Active smoking is an independent mortality risk factor (OR, 5.0) in patients with pneumococcal CAP after adjusting for age, influenza and pneumococcal vaccination, comorbidities (alcohol-related, heart, kidney, cerebrovascular, and neoplastic diseases), initial severity measured by CURB-65 score, severe sepsis,
Acknowledgments
Author contributions: S. B., R. M., and A. T. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. S. B. served as principal author. S. B., R. M., and A. T. contributed to the study design; S. B., R. M., A. T., S. R., R. Z., A. C., J. A., L. B., J. J. M.-V., I. A., F. R. d. C., J. R., L. M., and J. R.-M contributed to data acquisition; S. B., R. M., and A. T. contributed to data analysis and interpretation;
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FUNDING/SUPPORT: This study was supported by the Centro de investigación en red de enfermedades respiratorias, an initiative of the Instituto de Salud Carlos III [Fis Grant PI 041150]; Sociedad Española de Neumología y Cirugía torácica (SEPAR) and PII (SEPAR Research Programme) in respiratory infections [Grant 2007]; and a grant from the Ministry of Health of the Autonomous Community of Valencia [2007/0059].
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