Outcomes and Predictors of Severe Community-acquired Pneumonia Among Adults Admitted to the University of Gondar Comprehensive Specialized Hospital: A Prospective Follow-up Study

Figures & data

Table 1 Sociodemographic and Behavioral Characteristics of Patients Admitted to SCAP, UoGCSH, 2021 (n=239)

Variable	Category	Frequency	Percent (%)
Age	Median age of participants = 52 year, (Q1=36 and Q2=69)
Sex	Male	110	46.03
	Female	129	53.97
Residence	Urban	167	69.87
	Rural	69	28.87
	Refugee camp	3	1.26
Marriage	Married	149	62.34
	Single	50	20.92
	Separated	19	7.95
	Widowed	21	8.79
Religion	Orthodox	195	81.59
	Muslim	36	15.06
	Other	8	3.36
Occupation	Civil servant	40	16.74
	Merchant	28	11.72
	Farmer	57	23.85
	Housewife	57	23.85
	Self-employed	18	7.53
	Student	14	5.86
	Other (soldier, daily labor)	25	10.46
Education	No formal education	119	49.79
	Primary level	44	18.41
	Secondary level	43	17.99
	College and above	33	13.81
Smoking	Smoker	15	6.28
	Nonsmoker	224	93.72
Alcoholism	Alcoholic	60	25.10
	Nonalcoholic	179	74.89
Kat chewing	Yes	14	5.86
	No	225	94.14

Table 2 Comorbidities of Patients Hospitalized for SCAP at UoGCSH from May to September 2021 (n=239)

Variable	Category	Frequency	Percent (%)
Diabetes mellitus	Yes	36	15.06
	No	203	84.94
Hypertension	Yes	52	21.76
	No	187	78.24
HIV	Positive	22	9.21
	Negative	217	90.79
Cancer	Yes	17	7.11
	No	122	92.89
Pregnancy	Yes	7	5.43
	No	122	94.57
Cardiac disease	Yes	50	20.92
	No	189	79.08
CKD	Yes	12	5.02
	No	227	94.98
CLD	Yes	7	2.93
	No	232	97.07
COPD	Yes	14	5.86
	No	225	94.14
ILD	Yes	9	3.77
	No	230	96.23
Asthma	Yes	32	13.39
	No	207	86.61
Stroke (old)	Yes	9	3.77
	No	230	96.23
Corticosteroid	Yes	16	6.69
	No	223	93.31
Nutritional status (MUAC based)	Normal	144	60.25
	Undernourished	95	39.75

Abbreviations: HIV, human immunodeficiency virus; CLD, chronic liver disease; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; ILD, interstitial lung disease.

Table 3 Clinical Features of Patients Hospitalized for SCAP at UoGCSH from May to September 2021 (n=239)

Variable	Category	Frequency	Percent (%)
History and physical examination
Pneumonia diagnosis in last 3 months	Yes	50	20.92
	No	189	79.08
Antibiotic use in the past 3 months	Yes	59	24.69
	No	180	75.31
Level of consciousness	Conscious	189	79.08
	Confused^a	50	20.9
Pulse rate	Normal	30	12.55
	Tachycardia	209	87.45
Systolic BP	Normal	129	53.97
	Hypertension	50	20.92
	Hypotension	60	25.10
Diastolic BP	Normal	196	82.01
	Hypertension	28	11.72
	Hypotension	15	6.28
Temperature	Normal	104	43.51
	Fever	108	45.19
	Hypothermia	27	11.30
Respiratory rate	20–30	101	42.26
	30^a	138	57.74
Oxygen saturation (%)	<70	52	21.76
	70–90	187	78.24
White blood cell count	Normal	118	49.37
	Leukopenia	43	17.99
	Leukocytosis	78	32.64
Hemoglobin	Normal^a	143	59.83
	Anemia	96	40.17
Platelet	Normal^a	160	66.95
	Thrombocytopenia	79	33.05
Creatinine	Normal	206	86.19
	Elevated	33	13.81
Blood urea level	Normal	57	23.85
	Elevated	182	76.15
Sodium	Normal	100	53.48
	Hyponatremia	72	38.50
	Hypernatremia	15	8.02
Potassium	Normal	114	61.62
	Hypokalemia	69	37.30
	Hyperkalemia	2	1.08
Chest X-ray	Pneumonia	83	34.73
	Pneumonia^a	76	31.80
	Multifocal pneumonia	64	26.78
	Others^b	16	6.69
COVID-19 test	Positive	42	17.57
	Negative	73	30.54
	Not tested	124	51.88
Intubated	Yes	29	12.13
	No	210	87.87
Septic shock management	Yes	27	11.30
	No	212	88.70
Antibiotic type given	Ceftriaxone + vancomycin^a	122	51.05
	Ceftriaxone + doxycycline	31	12.97
	Ceftriaxone + azithromycin	71	29.71
	Others^c	15	2.93
Antibiotic changed (revised)	Yes	55	23.01
	No	184	76.99
CURB 65 score	≤2	154	64.44
	≥3	85	35.56

Notes: ^aEffusion, OAD, fibrosis, cardiomegaly – either coexist; ^bnormal, effusion, ARDS, fibrotic change – only one present; ^cceftriaxone + doxycycline, vancomycin or ceftriaxone + ciprofloxacin.

Abbreviation: BP, Blood Pressure.

Figure 1 Outcomes of hospitalized patients with SCAP at UoGCSH from May to September 2021 (n=239).

Table 4 Sociodemographic and Behavioral Characteristics as a Predictor of Unfavorable Outcome Among Hospitalized SCAP Patients at UoGCSH, May to September 2021 (n=239)

Variable	Category	Outcome
		Favorable	Percent (%)	Unfavorable	Percent (%)
Age	18–40	42	17.6	38	15.9
	41–64	46	19.24	32	13.4
	≥65	46	19.24	35	14.6
Sex	Male	56	23.4	54	22.6
	Female	78	32.6	51	21.6
Residence	Urban	94	39.3	76	31.8
	Rural	40	16.7	29	12.1
Marriage	Married	89	37.3	60	25.1
	Single	25	10.5	25	10.5
	Other	20	8.4	20	8.4
Occupation	Employed	37	15.5	21	8.8
	Unemployed	65	27.2	59	24.7
	Farmer	32	13.4	25	10.5
Education level	No formal education	46	26.4	56	23.4
	Primary level	25	10.5	19	7.9
	Secondary level and above	63	19.4	30	12.6
Smoking	Smoker	6	2.5	9	3.8
	Non smoker	127	53.1	96	40.2
Alcoholism	Alcoholic	28	11.7	32	13.4
	Non alcoholic	106	44.4	73	30.5
Kat chewing	Yes	6	2.5	8	3.3
	No	125	52.3	96	40.2

Table 5 Comorbidities as Predictor of Unfavorable Outcome Among Hospitalized SCAP Patients at UoGCSH, May to September 2021 (n=239)

Variable	Category	Favorable Outcome		Unfavorable Outcome
		Frequency	Percent	Frequency	Percent
Diabetes mellitus	Yes	17	7.11	19	7.95
	No	117	48.95	86	35.98
Hypertension	Yes	27	11.29	25	10.46
	No	74	30.96	59	24.68
HIV	Positive	11	10.58	11	10.58
	Negative	48	46.15	34	32.69
Cancer	Yes	8	3.35	9	3.77
	No	126	52.71	96	40.17
Pregnancy	Yes	4	3.10	3	2.32
	No	76	58.91	46	35.66
Cardiac disease	Yes	26	10.88	24	10.04
	No	108	45.19	81	33.89
CKD	Yes	5	2.09	7	2.93
	No	129	53.97	98	41
CLD	Yes	2	0.87	5	2.09
	No	132	55.23	100	41.84
COPD	Yes	8	3.35	6	2.51
	No	126	52.71	99	41.42
ILD	Yes	6	2.51	3	1.25
	No	128	53.6	102	42.68
Asthma	Yes	24	10.04	8	3.35
	No	110	46.03	97	40.59
Stroke (old)	Yes	1	0.42	8	3.35
	No	133	55.64	97	40.59
Nutritional status	Normal	85	35.56	59	24.69
	Undernourished	49	20.5	46	19.24

Abbreviations: HIV, human immunodeficiency virus; CLD, chronic liver disease; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; ILD, interstitial lung disease.

Table 6 History and Physical Exam Findings Related to Unfavorable Outcome Among Hospitalized SCAP Patients at UoGCSH, May to September 2021 (n=239)

Variable	Category	Favorable Outcome		Unfavorable Outcome
		Frequency	Percent	Frequency	Percent
Symptom duration	Median = 6 (IQR =7) days
Pneumonia diagnosis in last 3 months	Yes	26	10.88	24	10
	No	108	45.19	81	33.9
Antibiotic use in the past 3 months	Yes	29	12.13	30	12.6
	No	105	43.93	75	31.4
Level of consciousness	Conscious	124	51.88	65	27.2
	Confused^a	10	4.16	40	16.7
Pulse rate	Normal	20	8.37	10	4.2
	Tachycardia	114	47.69	95	39.7
Systolic BP	Normal	103	43.09	70	29.3
	Hypotension	4	1.67	12	5.0
	Hypertension	27	11.29	23	9.62
Diastolic BP	Normal	117	48.95	79	33.1
	Hypotension	4	1.67	11	4.6
	Hypertension	13	5.44	15	6.3
Temperature	Normal	64	26.78	40	16.7
	Hypothermia	9	3.77	18	7.5
	Fever	61	25.52	47	19.7
Respiratory rate	20–30	71	29.70	30	12.6
	30+	63	26.36	75	31.4
Oxygen saturation (%)	<70	114	47.69	20	8.4
	70–90	73	30.54	32	13.4

Note: ^aPatients who had poor mental status/condition from confusion up to lethargy, stuporous and coma.

Abbreviation: BP, Blood Pressure.

Table 7 Investigation Findings as Predictors of Unfavorable Outcome Among Hospitalized SCAP Patients at UoGCSH, May to September 2021 (n=239)

Variable	Category	Favorable Outcome		Unfavorable Outcome
		Frequency	Percent	Frequency	Percent
White blood cell	Normal	76	31.80	42	17.57
	Leukopenia	19	7.95	24	10.04
	Leukocytosis	39	16.32	39	16.32
Hemoglobin	Normal and polycythemia	97	40.59	46	19.24
	Anemia	37	15.48	59	24.68
Platelet	Normal^a	98	41	62	25.94
	Thrombocytopenia	36	15.06	43	17.99
Creatinine	Normal	125	52.30	81	33.89
	Elevated	9	3.77	24	10.04
Blood urea level	Normal	39	16.32	18	7.53
	Elevated	95	39.75	87	36.40
Sodium	Normal	66	35.29	34	18.18
	Hyponatremia	32	17.11	40	21.39
	Hypernatremia	5	1.60	10	2.67
Potassium	Normal	66	35.68	48	25.95
	Hypokalemia	35	18.92	34	18.34
	Hyperkalemia	1	0.54	1	0.54
Chest X-ray	Pneumonia	51	21.34	32	13.39
	Pneumonia^b	43	17.99	43	17.99
	Multifocal pneumonia	37	15.48	27	11.30
	Others^c	3	1.26	3	1.26
COVID-19 test	Positive	19	7.94	23	9.62
	Negative	45	18.83	28	11.72
	Not tested	70	29.28	54	22.59

Notes: ^aPatients who had normal and increased platlet count. ^bPatients who had radiologic diagnosis of pneumonia plus other radiologic findings (effusion, fibrosis, cardiomegally and obstructive airway disease. ^cIncludes patients who had normal, effusion only, obstructive airway disease only, fibrotic change only, or combination of these lists as CXR finding.

Table 8 Treatment Related Characteristics of Unfavorable Outcome Among Hospitalized SCAP Patients at UoGCSH, May to September 2021 (n=239)

Variable	Category	Favorable Outcome		Unfavorable Outcome
		Frequency	Percent	Frequency	Percent
CURB 65 score	≤2	102	42.68	52	21.76
	≥3	32	13.38	53	22.18
Antibiotic type given	Ceftriaxone + azithromycin	52	21.75	19	7.95
	Ceftriaxone + doxycycline	20	8.37	11	4.60
	Ceftriaxone + vancomycin	35	14.64	67	28.03
	Others^a	7	2.93	8	3.35
Antibiotic changed (revised)	Yes	7	2.93	48	20.00
	No	127	53.14	58	24.23
Intubated	Yes	9	3.77	20	8.37
	No	130	54.39	80	33.47
Septic shock management	Yes	7	2.93	20	8.37
	No	130	54.39	82	34.31
Length of hospital stay	1–7days	36	15.06	31	12.97
	>7 days	98	41.00	74	30.96

Note: ^aCeftriaxone + ciprofloxacin/cefepime/Augmentin/amoxicillin.

Table 9 Bivariable and Multivariable Logistic Regression Analysis of SCAP Patients Hospitalized at UoGCSH, 2021 (n=239).

Variable	Category	Favorable Outcome	Unfavorable Outcome	COR (95%CI)	AOR (95%CI)
Occupation	Employed	37	21	1	1
	Farmer	32	25	1.35 (0.58–3.15)	1.72 (0.5–5.94)
	Unemployed	65	59	1.20 (0.58–2.52)	2.83 (0.99–8.12)*
Asthma	Asthmatic	24	8	1	1
	Not asthmatic	110	97	3.76 (1.10–12.83)	0.72 (0.20–2.60)
Respiratory rate	20–30	71	30	1	1
	30+	63	75	3.21 (1.65–6.24)	1.22 (0.52–2.82)
Oxygen saturation	71–90	114	73	1	1
	<=70	20	32	3.88 (2.02–7.47)	0.89 (0.33–2.39)
Mental status	Conscious	124	65	1	1
	Confused^a	10	40	14.63 (7.03–30.44)	4.84 (1.47–15.88)***
CURB65	0–2	102	52	1	1
	≥3	32	53	5.63 (3.01–10.54)	1.28 (0.50–3.24)
Hemoglobin	Normal and polycythemia	97	46	1	1
	Anemia	37	59	3.76 (2.04–6.93)	2.36 (1.01–5.52)**
Platelet	Normal^b	98	62	1	1
	Thrombocytopenia	36	43	2.80 (1.53–5.105	0.41 (0.15–1.12)*
White blood cell count	Normal	76	42	1	1
	Leukopenia	19	24	4.40 (2.06–9.44)	4.38 (1.26–15.25)**
	Leukocytosis	39	39	1.49 (0.74–2.99)	3.15 (1.23–7.96)**
Creatinine	Normal	125	81		1
	Elevated	9	24	5.30 (2.45–11.43)	5.67 1.72–18.65)***
Urea	Normal	39	18	1	1
	Elevated	95	87	2.13 (0.98–4.66)	0.92 (0.34–2.48)
Antibiotic revision	Changed	7	48	1	1
	No revision	127	57	0.50 (0.26–0.96)	0.02 (0.01–0.07)***
Intubation	Not intubated	130	80	1	1
	Intubated	6	23	5.34 (2.38–12.02)	7.27 (1.58–33.37)**

Notes: ***p<0.01, **p<0.05, *p<0.1; model fitness with Hosmer–Lemeshow test, p=0.2563. ^aPatients who had poor mental status/condition from confusion up to lethargy, stuporous and coma. ^bPatients who had normal and increased platlet count.