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. 2009 May 26;6(5):e1000081.
doi: 10.1371/journal.pmed.1000081. Epub 2009 May 26.

Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study

Zitta B Harboe  1 , Reimar W Thomsen, Anders Riis, Palle Valentiner-Branth, Jens Jørgen Christensen, Lotte Lambertsen, Karen A Krogfelt, Helle B Konradsen, Thomas L Benfield
Affiliations

Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study

Zitta B Harboe et al. PLoS Med. .

Abstract

Background: Pneumococcal disease is a leading cause of morbidity and mortality worldwide. The aim of this study was to investigate the association between specific pneumococcal serotypes and mortality from invasive pneumococcal disease (IPD).

Methods and findings: In a nationwide population-based cohort study of IPD in Denmark during 1977-2007, 30-d mortality associated with pneumococcal serotypes was examined by multivariate logistic regression analysis after controlling for potential confounders. A total of 18,858 IPD patients were included. Overall 30-d mortality was 18%, and 3% in children younger than age 5 y. Age, male sex, meningitis, high comorbidity level, alcoholism, and early decade of diagnosis were significantly associated with mortality. Among individuals aged 5 y and older, serotypes 31, 11A, 35F, 17F, 3, 16F, 19F, 15B, and 10A were associated with highly increased mortality as compared with serotype 1 (all: adjusted odds ratio >or=3, p<0.001). In children younger than 5 y, associations between serotypes and mortality were different than in adults but statistical precision was limited because of low overall childhood-related mortality.

Conclusions: Specific pneumococcal serotypes strongly and independently affect IPD associated mortality.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Multivariate logistic regression analysis of serotype-specific 30-d mortality associated with IPD in children younger than 5 y (n = 1,581).
OR estimates adjusted for age (in years), sex, IPD focus (meningitis or bacteremia), time at diagnosis (in decades), alcoholism-related conditions, and low, medium, or high comorbidity score estimated by the Charlson index. The reference group was patients with IPD caused by serotype 1 in each group. ORs were calculated for serotypes with ≥50 IPD cases only.
Figure 2
Figure 2. Multivariate logistic regression analysis of serotype-specific 30-d mortality associated with IPD in patients aged 5 y or older (n = 17,277).
OR estimates adjusted for age (in years), sex, IPD focus (meningitis or bacteremia), time at diagnosis (in decades), alcoholism-related conditions, and low, medium, or high comorbidity score estimated by the Charlson index. The reference group was patients with IPD caused by serotype 1 in each group. ORs were calculated for serotypes with ≥50 IPD cases only.
Figure 3
Figure 3. Multivariate logistic regression analysis of serotype-specific 30-d mortality associated with IPD in meningitis patients aged 5 y or older (n = 2,248).
OR estimates adjusted for age (in years), sex, time at diagnosis (in decades), alcoholism-related conditions, and low, medium, or high comorbidity score estimated by the Charlson index. The reference group was patients with IPD caused by serotype 1 in each group. ORs were calculated for serotypes with ≥50 IPD cases only.
Figure 4
Figure 4. Multivariate logistic regression analysis of serotype-specific 30-d mortality associated with IPD in bacteremia patients aged 5 y or older (n = 15,029).
OR estimates adjusted for age (in years), sex, time at diagnosis (in decades), alcoholism-related conditions, and low, medium, or high comorbidity score estimated by the Charlson index. The reference group was patients with IPD caused by serotype 1 in each group. ORs were calculated for serotypes with ≥50 IPD cases only.
Figure 5
Figure 5. Multivariate logistic regression analysis of serotype-specific 30-d mortality associated with IPD in patients aged 5 y or older with low comorbidity level (Charlson 0) (n = 9,059).
OR estimates controlled for age (in years), sex, IPD focus (meningitis or bacteremia), time at diagnosis (in decades), alcoholism-related conditions. The reference group was patients with IPD caused by serotype 1 in each group. ORs were calculated for serotypes with ≥50 IPD cases only.
Figure 6
Figure 6. Multivariate logistic regression analysis of serotype-specific 30-d mortality associated with IPD in patients aged 5 y or older with intermediate comorbidity level (Charlson 1–2) (n = 5,536).
OR estimates controlled for age (in years), sex, IPD focus (meningitis or bacteremia), time at diagnosis (in decades), alcoholism-related conditions. The reference group was patients with IPD caused by serotype 1 in each group. ORs were calculated for serotypes with ≥50 IPD cases only.
Figure 7
Figure 7. Multivariate logistic regression analysis of serotype-specific 30-d mortality associated with IPD in patients aged 5 y or older with high comorbidity level (Charlson 3+) (n = 2,682).
OR estimates controlled for age (in years), sex, IPD focus (meningitis or bacteremia), time at diagnosis (in decades), alcoholism-related conditions. The reference group was patients with IPD caused by serotype 1 in each group. ORs were calculated for serotypes with ≥50 IPD cases only.
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