An analysis of 52 studies from 18 countries indicates that mortality among pneumonia patients admitted to intensive care units (ICUs) remains high in low- and middle-income countries (LMICs), researchers reported last week in NEJM Evidence.
The systematic review and meta-analysis, conducted by researchers in Brazil, aimed to synthesize current evidence on mortality in patients with community-acquired pneumonia (CAP) admitted to an ICU.
CAP is already known to be a leading cause of ICU admission and a major contributor to mortality in LMICs, despite advances in diagnostics, antibiotic therapy, and organ support. With the population of people 65 and older expected to triple in LMICs in coming years, the researchers wanted to get a better understanding of CAP outcomes.
“The convergence of population aging and high CAP incidence will likely amplify ICU demand, strain workforce capacity, and increase the economic and social burden of disease through prolonged disability, absenteeism, and productivity loss,” they wrote.
37% pooled mortality rate
The included studies had data on 48,707 CAP patients (mean age, 65.4 years; 60.8% male) from 18 countries. Nearly half of the studies (25) were conducted in China.
The most frequent comorbidities were hypertension, chronic obstructive pulmonary disease, and diabetes. Streptococcus pneumoniae was the most commonly identified pathogen in the 22 studies with microbiologic information. The researchers also noted high rates of smoking in study populations.
The convergence of population aging and high CAP incidence will likely amplify ICU demand, strain workforce capacity, and increase the economic and social burden of disease through prolonged disability, absenteeism, and productivity loss.
The pooled short-term (28- and 30-day) mortality rate was 37.1%, rising to 61% among patients who required mechanical ventilation. Further analysis showed that age and mechanical ventilation were the biggest predictors of mortality.
The authors say the observed mortality rate among patients in LMIC’s is higher than that previously reported in large multinational cohorts that included data from high-income countries.
“These differences likely reflect case-mix but also variation in care delivery, resource availability, and delays in ICU admission,” they wrote. “Such variability underscores the importance of contextualized data to inform national policies.”
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