Clinical Profile and Predictors of In-Hospital Mortality Among Patients Admitted with Community-Acquired Pneumonia: Prospective Observational Study

Original Article

Abstract

Background: Despite improvements in antimicrobial therapy, community-acquired pneumonia (CAP) is still a significant cause of hospitalization and in-hospital mortality. Prompt identification of those at high risk of adverse outcomes is crucial for prompt intervention and better outcomes.

Objective:  To evaluate the clinical profile of adults hospitalized with community-acquired pneumonia (CAP) and identify independent predictors of in-hospital mortality.

Methodology: This prospective observational study was conducted over 12 months (1 January 2025 to 31 December 2025) at Nowshera Medical College, Pakistan. A total of 100 consecutive adult patients diagnosed with community-acquired pneumonia were enrolled using non-probability consecutive sampling. Demographic characteristics, clinical presentation, comorbidities, laboratory findings, CURB-65 score, treatment details, and hospital outcomes were recorded using a structured data collection form. Data were analyzed using IBM SPSS Statistics version 26.0. Comparisons between survivors and non-survivors were performed using the independent-samples t-test and Chi-square/Fisher's exact test. Multivariable logistic regression was performed to identify independent predictors of in-hospital mortality. A p-value <0.05 was considered statistically significant.

Results:  The mean age of the participants was 61.8 ± 15.2 years, and 62% were male. Hypertension (45%), diabetes mellitus (37%), chronic obstructive pulmonary disease (29%), and chronic kidney disease (15%) were the most common comorbidities. Fever (88%), cough (84%), and dyspnea (79%) were the predominant presenting symptoms. Sixteen patients (16%) died during hospitalization. Non-survivors were significantly older and had higher respiratory rate, serum urea level, and CURB-65 score, while oxygen saturation at admission was significantly lower (all p <0.05). Multivariable logistic regression demonstrated that age ≥65 years (AOR 2.84, 95% CI 1.19–6.81; p=0.021), CURB-65 score ≥3 (AOR 4.97, 95% CI 2.01–12.31; p=0.001), oxygen saturation <90% (AOR 3.42, 95% CI 1.47–7.96; p=0.004), and chronic kidney disease (AOR 2.76, 95% CI 1.09–6.98; p=0.032) were independent predictors of in-hospital mortality.

Conclusion: Community-acquired pneumonia remains a significant cause of in-hospital morbidity and mortality among adults. Advanced age, higher CURB-65 score, hypoxemia at admission, and chronic kidney disease were independent predictors of in-hospital mortality. Early risk stratification and timely evidence-based management may improve clinical outcomes.