Clinical research studyCommunity-acquired pneumonia as the initial manifestation of serious underlying diseases
Section snippets
Study design and setting
For a 5-year period (January 1998 to December 2002), all patients with community-acquired pneumonia diagnosed at the emergency room of the Arnau de Vilanova Hospital in Lleida (Catalonia, Spain) were included in a prospective study on epidemiologic, clinical, microbiologic, and outcome parameters. This study was examined and approved by the scientific and ethics committees of the institution.
Study and follow-up of patients
On enrollment (first visit), all patients underwent a complete clinical history and physical
Results
We evaluated a total of 726 episodes of community-acquired pneumonia, based on the clinical and radiologic findings at entry. We excluded 66 patients for the following reasons: an erroneous diagnosis of pneumonia (59), recent hospitalization (4), and failure to obtain informed consent.3 In consequence, 660 patients constituted the final study group.
Five-hundred and twenty-nine (80%) were hospitalized and 131 were managed as outpatients. During follow-up, 58 (9%) patients died, all in the
Discussion
This study shows that community-acquired pneumonia can be the first manifestation of previously unknown underlying diseases. Thus, we found 1 or more new serious comorbid conditions in more than 6% of our patients; diabetes mellitus, neoplasm (particularly lung and hematologic malignancies), chronic obstructive pulmonary disease, and HIV infection were the most frequently recognized coexisting illnesses. The detection of unknown comorbid conditions was particularly frequent in patients who had
Acknowledgment
We thank Roman Pallares, MD for his critical review of the manuscript.
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