Pneumococcal and influenza vaccination status of hospitalized adults with community acquired pneumonia and the effects of vaccination on clinical presentation

Figures & data

Table 1. Demographic and clinical characteristics of the study population.

	NV (n = 378)	FV (n = 45)	PV (n = 13)	BV (n = 30)	P value
Age	67 (18–94)	71 (36–90)	76 (60–89)	70 (31–88)	0.002^*
Residence- n %					0.410
House	370 (97.9%)	45 (100%)	13 (100%)	28 (93.3%)
Nursing home	6(1.6%)	0 (0%)	0(0%)	2 (6,7%)
Other	2 (0.5%)	0 (0%)	0(0%)	0(0%)
Current/former smoker- n %	241 (64.1%)	31(70.5%)	9(69.2%)	20(66.7%)	0.838
Cough- n %	342 (%93.4)	44 (%97.8)	13 (%100)	28 (93.3%)	0.737
Fever- n %	250 (70.8%)	33 (73.3%)	12 (92.3%)	23 (76.7%)	0.352
Flank pain- n %	139 (43.2%)	21 (46.7%)	5 (%38.5)	13 (43.3%)	0.954
Fatigue- n %	254 (74,5%)	27(60%)	9(69,2%)	14(46,7%)	0.004†
Muscle pain - n %	98 (31.2%)	7 (15.9%)	1 (7.7%)	5 (17.2%)	0.027^♯
Headache- n %	62 (19.7%)	7 (15.6%)	2 (15.4%)	2 (6.7%)	0.325
GI symptoms- n %	72(22.9%)	11(25.6%)	3(23.1%)	0(0%)	0.029‡
Altered consciousness-n %	40 (10.6%)	3 (6.7%)	2 (15.4%)	3 (10%)	0.772
Systolic BP (mmHg)	120 (70–230)	120 (90–170)	110 (80–150)	120 (80–170)	0.059
Pulse rate/minute	98 (56–205)	90 (60–131)	96 (70–130)	93 (60–134)	0.375
Respiratory rate/minute	25 (12–48)	24 (16–42)	25 (20–30)	25 (16–38)	0.751
Body temperature (°)	37.7 (35.739.8)	38 (36–39)	38 (36–38.9)	38 (36–39.5)	0.295

* Significant difference between PV and NV groups.

^† Significant difference between BV and NV groups.

^♯ Although there was a significant difference between the four groups, no significant difference was observed in paired comparisons.

^‡ Significant difference between the BV group and the other three groups.

Numerical values are given as median (min-max).

GI: gastrointestinal, BP: blood pressure

Table 2. Vaccination status according to comorbidities.

	NV (n = 378)	FV (n = 45)	PV (n = 13)	BV (n = 30)
Diabetes mellitus	75 (79.8%)	13 (13.8%)	1 (1.1%)	5 (5.3%)
Coronary artery disease	84 (82.4%)	10 (9.8%)	3 (2.9%)	5 (4.9%)
Cerebrovascular disease	29 (72.5%)	5 (12.5%)	2 (5%)	4 (10%)
Congestive heart failure	33 (73.3%)	9 (20%)	0 (0%)	3 (6.7%)
Chronic renal failure	13 (81.2%)	2 (12.5%)	1 (6.2%)	0 (0%)
Chronic liver disease	8 (88.9%)	1 (11.1%)	0 (0%)	0 (0%)
Asthma	20 (69%)	7 (24.1%)	0 (0%)	2 (6.9%)
Malignancy	29 (67.4%)	9 (20.9%)	3 (7%)	2 (4.7%)
COPD	94 (71.2%)	17 (12.9%)	3 (2.3%)	18 (13.6%)
Other	113 (82.5%)	12 (8.8%)	6 (4.4%)	6 (4.4%)
No comorbidity	66 (94.3%)	2 (2.9%)	1 (1.4%)	1(1.4%)

As most patients had more than one comorbidity, the numbers do not add up to 466. The data are presented as the number (%) of patients with the related comorbidity. COPD: chronic obstructive pulmonary disease

Table 3a. Independent correlates of receiving pneumococcal vaccine.

Variables for receipt of pneumococcal vaccine	No (%) of vaccinated patients	OR (95%CI)	P value
Age			0.306
≥ 65 y	30 (69.8%)	1.49 (0.69–3.23)
<65 y	13 (30.2%)	1.00 (ref.)
Comorbidities
Present	41 (95.3%)	1.82 (0.38–8.54)	0.447
Absent	2 (4.7%)	1.00 (ref.)
Current/former smoker	29 (67.4%)	1.01 (0.47–2.18)	0.966
Non-smoker	14 (32.6%)	1.00 (ref.)
Influenza vaccination
Yes	30 (69.8%)	17.8 (8.56–37.01)	<0.001
No	13 (30.2%)	1.00 (ref.)

Table 3b. Independent correlates of receiving influenza vaccine.

Variables for receipt of influenza vaccine	No (%) of vaccinated patients	OR (95%CI)	P value
Age			0.663
≥ 65 y	49 (65.3%)	1.14 (0.62–2.07)
<65 y	26 (18.4%)	1.00 (ref.)
Comorbidities
Present	71 (95.9%)	3.79 (1.08–13.31)	0.037
Absent	3 (4.1%)	1.00(ref.)
Current/former smoker	51 (68.9%)	1.16 (0.63–2.14)	0.628
Non-smoker	23 (31.1%)	1.00(ref.)
Pneumococcal vaccination			<0.001
Yes	30 (40%)	18.1 (8.75–37.83)
No	45 (60%)	1.00(ref.)

Table 4. Radiologic findings according to the vaccination status.

Chest X-ray	NV (n = 378)	FV (n = 45)	PV (n = 13)	BV (n = 30)	P value
Consolidation	287(%75.9)	26 (%57.8)	5 (%38.5)	14 (%46.7)	<0.001^‡
Interstitial/patchy	135(%35.7)	28 (%62.2)	11(%84.6)	21(%70)	<0.001^†
Cavitation	18 (%4.8)	2 (%4.4)	1 (%7.7)	0 (%0)	0.536
Multilobar involvement	67(%17.7)	11(%24.4)	4(%30.8)	7(%23.3)	0.425
Pleural effusion	71(%18.8)	4(%9.1)	0 (%0)	5(%16.7)	0.143

^‡ The patients who had received neither vaccine (NV) were significantly more likely to present with consolidation on chest X-ray than the patients who had received both vaccines (BV) or the just pneumococcal vaccine (PV).

^† The patients who had received neither vaccine (NV) had a lower frequency of interstitial/patchy infiltrates on chest X-ray than the patients who had received either or both vaccines.

Table 5. Clinical outcomes in the 4 vaccination groups.

	NV (n = 378)	FV (n = 45)	PV (n = 13)	BV (n = 30)	P value
Length of hospital stay (days)	7 (2–55)	7 (2–23)	9 (3–20)	6 (2–21)	0.171
ICU admission (n)	25 (6.6%)	2 (4.4%)	1 (7.7%)	1 (3.3%)	0.802
30-day mortality (n)	18 (9.6%)	4 (22.2%)	2 (16.7%)	0 (0%)	0.258

Numerical values are given as median (min-max)

ICU: intensive care unit

Table 6. Logistic regression analysis: Independent correlates for ICU admission in hospitalized patients with CAP.

Variables	OR (95%CI)	P value
Age ≥ 65 y	0.47 (0.18–1.20)	0.116
Age<65 y	1.00(ref.)
Influenza vaccination administered	0.51 (0.12–2.14)	0.358
NOT administered	1.00(ref.)
Pneumococcal vaccination administered	1.06 (0.19–5.91)	0.942
NOT administered	1.00(ref.)
Presence of comorbidities	0.42 (0.11–1.64)	0.215
Absence of comorbidities	1.00(ref.)
Current/former smoker	0.66 (0.28–1.59)	0.363
Non-smoker	1.00(ref.)
PSI class IV-V	25.39 (2.78–231.64)	0.004
PSI class I-II-III	1.00(ref.)
CURB-65 ≥ 3	3.66 (1.31–10.26)	0.013
CURB-65 < 3	1.00(ref.)
Multilobar involvement	3.54 (1.42–8.80)	0.006
NOT Multilobar involvement	1.00(ref.)

PSI: Pneumonia severity index