J Korean Soc Emerg Med.  2019 Jun;30(3):265-272. 10.0000/jksem.2019.30.3.265.

Seasonal trend and mortality in adults with viral pneumonia

• Lee JY
• Kim YJ
• Lee ES
• Lee YS

• KMID: 2450135
• DOI: http://doi.org/10.0000/jksem.2019.30.3.265

Abstract

OBJECTIVE
Viral infections are being identified increasingly in patients with pneumonia and can be fatal, particularly in immune-compromised patients. This study examined the seasonal trend and mortality in adult patients with viral pneumonia.
METHODS
Retrospective data of adult patients who visited the emergency room and were diagnosed with viral pneumonia was collected between January 2012 and December 2015 at a tertiary referral center. The monthly incidence of each viral pathogen and in-hospital mortality were analyzed.
RESULTS
A total of 1,179 patients were analyzed. The mean age was 66.0 years and male comprised 60.0% of cases. Multiple viral infections and viral-bacterial co-infection were found in 5.2% and 24.7% of patients, respectively. The underlying diseases were as follows: diabetes mellitus in 32.8%, malignancy in 30.3%, and chronic lung disease in 30.9%. In-hospital mortality occurred in 7.9% of the total patients. Rhinovirus was the most common viral pathogen throughout the year. Influenza A was the most common from January to March and rhinovirus was the most common from September to November. Among the viral pathogens, a coronavirus infection resulted in the highest mortality of 12.6% but there was no significant difference in mortality among the viral pathogens. Multivariate analysis for in-hospital mortality revealed a viral-bacterial co-infection (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.02-2.34), malignancy (OR, 2.34; 95% CI, 1.48-3.71), C-reactive protein (CRP; OR, 1.04; 95% CI, 1.02-1.07), CURB-65 score 2 (OR, 2.46; 95% CI, 1.47-4.12), and CURB-65 score ≥3 (OR, 4.60; 95% CI, 2.31-9.16) to be significantly associated with mortality.
CONCLUSION
The outcome from viral pneumonia was poor in adult patients. A viral-bacterial co-infection, malignancy, elevated CRP, and CURB-65 score were significant predictors of mortality.

Keyword

Viral pneumonia; Mortality; Risk factors; Outcome

MeSH Terms

Adult*
C-Reactive Protein
Coinfection
Coronavirus Infections
Diabetes Mellitus
Emergency Service, Hospital
Hospital Mortality
Humans
Incidence
Influenza, Human
Lung Diseases
Male
Mortality*
Multivariate Analysis
Pneumonia
Pneumonia, Viral*
Retrospective Studies
Rhinovirus
Risk Factors
Seasons*
Tertiary Care Centers
C-Reactive Protein