Features of post-obstructive pneumonia in advanced lung cancer patients, a large retrospective cohort

Abstract

Background

Post-obstructive pneumonia refers to an infection of the lung parenchyma distal to a bronchial obstruction. Previous experience-based studies reported a high prevalence of this infection among patients with a medical history of advanced lung neoplasia, up to 40–55%.

Objectives

The current study was designed to investigate the features of post-obstructive pneumonia in lung cancer, including its predictors and the discriminants for 30-day mortality.

Method

Data from medical records at the tertiary University centre, UZ Brussel, were collected retrospectively between January 2016 and January 2021. Patients affected by lung cancer stages III and IV were included. A multidisciplinary team, composed of a pulmonologist, an infectious disease specialist and a chest radiologist, identified patients affected by post-obstructive pneumonia.

Results

A total of 408 patients were included, of which 46 (11%) were diagnosed with post-obstructive pneumonia. Multivariable logistic regression for predictors of disease onset found significant differences for squamous cell carcinoma (OR:2.46 p-value: .014) and hilar location of the tumour (OR:2.72 p-value: .021). However, no significant differences were identified with regards to age or comorbidities. Furthermore, 30-day mortality among post-obstructive pneumonia patients was 30%. Multivariable logistic regression for prediction of 30-day mortality found significant differences in CURB-65 score (OR:73.20 p-value: .001) and smoking status (OR:0.009 p-value: .015)

Conclusions

Within this cohort, the prevalence of post-obstructive pneumonia in advanced lung cancer patients was lower than previously reported. Squamous cell carcinoma and a hilar tumour location were two variables associated with disease development, independent of age and comorbidities. Furthermore, a higher CURB-65 score at post-obstructive pneumonia diagnosis was correlated with mortality.

Keywords:

• Post-obstructive pneumonia
• lung cancer
• squamous cell carcinoma
• CURB-65 score
• active smoking

Acknowledgements

The authors express gratitude for the logistic support offered by the oncology coordinating study team and the study nurses.

Ethics approval and consent to participate

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was conducted in accordance with the study protocol, the Declaration of Helsinki and applicable regulatory requirements. The local Institutional Review Board and Ethics Committee of the University Hospital Brussels approved the protocol (EC approval number: B1432021000531). In view of the retrospective nature of the study, which did not demand a deviation from standard clinical care, and the fact that all data was anonymized, informed consent from the patient or the next of kin was not essential.

Author contributions

MM: concept, study design, data collection, data analysis and interpretation, writing and revision, SW and SD: data collection and writing and revision, KV: study concept, writing and revision, JvL: writing and revision, BI: data collection, writing and revision, EV: study concept, writing and revision. All authors have given final approval of the version to be submitted.

Disclosure statement

All other authors declare that they have no competing interests in relation to the content published in this manuscript.

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.