Comparison of clinical outcomes in hospitalized patients with COVID-19 or non-COVID-19 community-acquired pneumonia in a prospective observational cohort study

Abstract

Purpose: Coronavirus disease 2019 (COVID-19) and non-COVID-19 community-acquired pneumonia (NC-CAP) often result in hospitalization with considerable risks of mortality, ICU treatment, and long-term morbidity. A comparative analysis of clinical outcomes in COVID-19 CAP (C-CAP) and NC-CAP may improve clinical management.

Methods: Using prospectively collected CAPNETZ study data (January 2017 to June 2021, 35 study centers), we conducted a comprehensive analysis of clinical outcomes including in-hospital death, ICU treatment, length of hospital stay (LOHS), 180-day survival, and post-discharge re-hospitalization rate. Logistic regression models were used to examine group differences between C-CAP and NC-CAP patients and associations with patient demography, recruitment period, comorbidity, and treatment.

Results: Among 1368 patients (C-CAP: n = 344; NC-CAP: n = 1024), C-CAP showed elevated adjusted probabilities for in-hospital death (aOR 4.48 [95% CI 2.38-8.53]) and ICU treatment (aOR 8.08 [95% CI 5.31-12.52]) compared to NC-CAP. C-CAP patients were at increased risk of LOHS over seven days (aOR 1.88 [95% CI 1.47-2.42]). Although ICU patients had similar in-hospital mortality risk, C-CAP was associated with length of ICU stay over seven days (aOR 3.59 [95% CI 1.65-8.38]). Recruitment period influenced outcomes in C-CAP but not in NC-CAP. During follow-up, C-CAP was linked to a reduced risk of re-hospitalization and mortality post-discharge (aOR 0.43 [95% CI 0.27-0.70]).

Conclusion: Distinct clinical trajectories of C-CAP and NC-CAP underscore the need for adapted management to avoid acute and long-term morbidity and mortality amid the evolving landscape of CAP pathogens.

Keywords: COVID-19; Community-acquired pneumonia; Observational cohort study; SARS-CoV-2.

Fig. 1

Patient flowchart. Ticks (✓) indicate inclusion criteria, crosses ( × ) exclusion criteria for CAPNETZ (left) and CAPNETZ-PROVID participation. *) Pneumonia onset ≥ 48 h after hospitalization or hospitalization during the last 28 days. **) Recent chemotherapy, neutropenia, recent systemic steroid therapy or history of solid organ or stem cell transplant ***) Fever, cough, purulent sputum, or rales/crackles in pulmonary auscultation at screening visit. ****) Applies after pandemic onset. CAPNETZ: competence network community-acquired pneumonia, PROVID: Clinical, Molecular and Functional Biomarkers for Prognosis, Pathomechanisms and Treatment Strategies of COVID-19, SARS-CoV-2: severe acute respiratory syndrome coronavirus 2, PCR: polymerase chain reaction, NC-CAP: non-COVID-19 community-acquired pneumonia, C-CAP: COVID-19 community-acquired pneumonia

Fig. 2

Distribution of hospitalization status from admission until 28 days after hospitalization in all patients and ICU patients with C-CAP or NC-CAP. X-axes depict time (d) from hospitalization, Y-axes the rate of patients (%). Green bars represent the percentage of discharged patients, yellow bars the percentage of hospitalized patients, and blue bars the percentage of participants who died in the hospital. The right plots describe the trajectory of the C-CAP participants; the left plots of the NC-CAP participants. ICU: intensive care unit, NC-CAP: non-COVID-19 community-acquired pneumonia, C-CAP: COVID-19 community-acquired pneumonia

Fig. 3

Time-to-event analysis of length of hospital stay. X-axes represent time (days) after hospital admission, Y-axes the rate of patients remaining hospitalized. Blue curves represent participants with COVID-19 CAP, orange curves non-COVID-19 CAP. Plus ( + ) sign indicates censoring (at day 28 after hospital admission). Dashed lines represent median length of hospital stay. a) Time from hospital admission to hospital discharge in survivors of hospitalization. b) Time from hospital admission to in-hospital death in participants who deceased during the hospital stay. c) Time from hospital admission to hospital discharge in ICU (intensive care unit) treated survivors of hospitalization. d) Time from admission to in-hospital death in ICU-treated non-survivors of hospitalization. NC-CAP: non-COVID-19 community-acquired pneumonia, C-CAP: COVID-19 community-acquired pneumonia. No: number