Mortality in the thirteen years following invasive pneumococcal disease
Year: 2025
Type: article
Study design: Observational Study
Abstract: • There is existing published evidence that invasive pneumococcal disease (IPD, the presence of Streptococcus pneumoniae at a normally sterile body site) is independently associated with increased longer-term mortality. • This study provides longer-term follow up than other adult studies of IPD, establishing factors associated with late mortality at a range of time scales as well as the major causes of death following IPD. • Our findings add weight to the hypothesis that the mechanism of increased long-term mortality following IPD is that older and more frail patients are at highest risk of infection, which destabilises existing comorbidities, leading to earlier death; rather than the hypothesis of persistent low-grade inflammation. • We also noted that IPD patients were often subsequently diagnosed with new malignancy. Enhanced understanding of mortality following IPD can allow for more targeted interventions. Traditionally considered an acute disease, there is increasing evidence that Invasive Pneumococcal Disease (IPD) is associated with higher longer-term mortality than might be expected (1–3). To investigate IPD mortality over a prolonged time-period and identify predictors and causes of early versus later mortality. A previous retrospective cohort study was undertaken with 207 consecutive adult patients diagnosed with IPD at Hull University Teaching Hospitals NHS Trust, 2007–2009. The present study followed this cohort to 2023. Clinical notes were reviewed and patient characteristics and causes of death recorded. United Kingdom life expectancy tables were used to calculate expected remaining years of life according to patient age and calculate the difference between the observed and expected life years, stratified by potential predictor variables to identify associations with loss of life-years (4). Piecewise multivariate Cox Proportional Hazards (CPH) models were constructed to identify statistically significant predictors for early, medium-term, and long-term mortality. 21 % of patients died within 30 days, 39 % by 2 years, and 69 % by 13 years. Most early deaths, according to death certification, were due to infection, whereas later deaths were predominantly due to malignancy or infection. Compared to the Hull region, there were significantly more deaths from infection and malignancy, and fewer from cardiovascular disease. The total difference between observed and expected was 985 years for the cohort. Age, Charlson score, and pyrexia on admission were significant predictors of late mortality. Age and comorbidity burden are predictors of mortality after IPD with infection and malignancy being important causes of later mortality. Clinicians should be mindful of undiagnosed malignancies when managing IPD and consider reviewing the stability of existing comorbidities either prior to or shortly after discharge from hospital.
Source: Clinical Infection in Practice
Authors: William P.W. Smith, Chloe Walsh, Gavin Barlow
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
OpenAlex ID: W4407367352