Tobacco Smoking Increases the Risk for Death From Pneumococcal Pneumonia

Autores de IIS La Fe

• Salvador Bello Dondra

  Autor

• Rosario Menéndez Villanueva

  Autor

• Antonio Torres Marti

  Autor

• Soledad Reyes Calzada

  Autor

• Rafael Zalacain Jorge

  Autor

• Javier Aspa Marco

  Autor

• Luis Borderias Clau

  Autor

• Juan Jose Martin Villasclaras

  Autor

• Inmaculada Alfageme Michavilla

  Autor

• Felipe Rodriguez De Castro

  Autor

• Jordi Rello Condomines

  Autor

• Luis Molinos Martin

  Autor

• Juan Ruiz Manzano

  Autor

Participantes ajenos a IIS La Fe

• Capelastegui A

Grupos

• Infecciones Respiratorias

Abstract

BACKGROUND: Active smoking increases the risk of developing community-acquired pneumonia (CAP) and invasive pneumococcal disease, although its impact on mortality in pneumococcal CAP outcomes remains unclear. The aim of this study was to investigate the influence of current smoking status on pneumococcal CAP mortality. METHODS: We performed a multicenter, prospective, observational cohort study in 4,288 hospitalized patients with CAP. The study group consisted of 892 patients with pneumococcal CAP: 204 current smokers (22.8%), 387 nonsmokers (43.4%), and 301 exsmokers (33.7%). RESULTS: Mortality at 30 days was 3.9%: 4.9% in current smokers vs 4.3% in nonsmokers and 2.6% in exsmokers. Current smokers with CAP were younger (51 years vs 74 years), with more alcohol abuse and fewer cardiac, renal, and asthma diseases. Current smokers had lower CURB-65 (confusion, uremia, respiratory rate, BP, age >= 65 years) scores, although 40% had severe sepsis at diagnosis. Current smoking was an independent risk factor (OR, 5.0; 95% CI, 1.8-13.5; P = .001) for 30-day mortality of pneumococcal CAP aft er adjusting for age (OR, 1.06; P = .001), liver disease (OR, 4.5), sepsis (OR, 2.3), antibiotic adherence to guidelines, and first antibiotic dose given, 6 h. The independent risk effect of current smokers remained when compared only with nonsmokers (OR, 4.0; 95% CI, 1.3-12.6; P = .015) or to exsmokers (OR, 3.9; 95% CI, 1.09-4.95; P = .02). CONCLUSIONS: Current smokers with pneumococcal CAP oft en develop severe sepsis and require hospitalization at a younger age, despite fewer comorbid conditions. Smoking increases the risk of 30-day mortality independently of tobacco-related comorbidity, age, and comorbid conditions. Current smokers should be actively targeted for preventive strategies.