Science and Research

Do-not-resuscitate orders in patients with community-acquired pneumonia: a retrospective study

BACKGROUND: To investigate the use of do-not-resuscitate (DNR) orders in patients hospitalized with community-acquired pneumonia (CAP) and the association with mortality. METHODS: We assembled a cohort of 1317 adults hospitalized with radiographically confirmed CAP in three Danish hospitals. Patients were grouped into no DNR order, early DNR order (≤48 h after admission), and late DNR order (> 48 h after admission). We tested for associations between a DNR order and mortality using a cox proportional hazard model adjusted for patient and disease related factors. RESULTS: Among 1317 patients 177 (13%) patients received a DNR order: 107 (8%) early and 70 (5%) late, during admission. Patients with a DNR order were older (82 years vs. 70 years, p < 0.001), more frequently nursing home residents (41% vs. 6%, p < 0.001) and had more comorbidities (one or more comorbidities: 73% vs. 59%, p < 0.001). The 30-day mortality was 62% and 4% in patients with and without a DNR order, respectively. DNR orders were associated with increased risk of 30-day mortality after adjustment for age, nursing home residency and comorbidities. The association was modified by the CURB-65 score Hazard ratio (HR) 39.3 (95% CI 13.9-110.6), HR 24.0 (95% CI 11.9-48,3) and HR 9.4 (95% CI: 4.7-18.6) for CURB-65 score 0-1, 2 and 3-5, respectively. CONCLUSION: In this representative Danish cohort, 13% of patients hospitalized with CAP received a DNR order. DNR orders were associated with higher mortality after adjustment for clinical risk factors. Thus, we encourage researcher to take DNR orders into account as potential confounder when reporting CAP associated mortality.
  • Egelund, G. B.
  • Jensen, A. V.
  • Petersen, P. T.
  • Andersen, S. B.
  • Lindhardt, BØ
  • Rohde, G.
  • Ravn, P.
  • von Plessen, C.

Keywords

  • Aged
  • Aged, 80 and over
  • Community-Acquired Infections/mortality/*therapy
  • Comorbidity
  • Denmark/epidemiology
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Pneumonia/complications/epidemiology/mortality/*therapy
  • Proportional Hazards Models
  • *Resuscitation Orders
  • Retrospective Studies
  • Risk
  • Time Factors
  • Treatment Outcome
  • Community-acquired pneumonia
  • Do not resuscitate orders
  • Mortality
  • Essex Pharma, MSD and Novartis for lectures including service on speaker’s bureaus
  • outside the submitted work and personal fees from GSK for
  • travel/accommodations/meeting expenses, outside the submitted work. Dr. Ravn reports
  • personal fees from MSD, Abb Vie and CSL Behring as invited speaker, outside the
  • submitted work. Dr. Ravn reports personal fees from Statens Serum Institute as data
  • safety monitoring board member, outside the submitted work. Dr. Ravn reports
  • non-financial research collaboration with Astellas outside the submitted work. The
  • remaining authors declare no other conflict of interest.
Publication details
DOI: 10.1186/s12890-020-01236-1
Journal: BMC Pulm Med
Pages: 201 
Number: 1
Work Type: Original
Location: Assoziierter Partner, BREATH
Disease Area: PALI
Partner / Member: CAPNETZ, MHH
Access-Number: 32709220

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