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18-05-2014 | Infectious disease | Article

Current smoking heralds worse outcomes in pneumococcal CAP


Free abstract

medwireNews: Hospital patients with pneumococcal community-acquired pneumonia (CAP) have worse outcomes if they are current smokers than if they are non- or ex-smokers, results of a large observational study suggest.

Current smoking was associated with earlier hospitalisation, a higher risk of developing sepsis and higher 30-day mortality, leading the study authors to call for smokers to be “actively targeted for preventive strategies”.

The study, by Salvador Bello (Hospital Universitario Miguel Servet, Zaragoza, Spain) and co-workers, was a prospective multicentre cohort study of 892 patients hospitalised with CAP. All had microbiological evidence of Streptococcus pneumonia infection.

In all, 204 (22.8%) were current smokers, 301 (33.7%) were ex-smokers and 387 (43.4%) were nonsmokers.

Analysis of patients according to smoking status revealed differences in demographical and clinical characteristics. For instance, current smokers were significantly younger than others (51 vs 74 years on average), were more likely to be male (73.0 vs 60.3%) and were less likely to have comorbid asthma, renal or cardiac disease.

Current smokers were more likely than others to report significant alcohol abuse and to have comorbid severe liver disease.

Interestingly, current smokers were much less likely than others to be classified as having high initial disease severity (based on a CURB-65 score of 2 or more) but had a higher rate of bacteraemic CAP and an equivalent rate of severe sepsis.

At 30 days, mortality was significantly higher among current and nonsmokers than in ex-smokers, at 4.9%, 4.3% and 2.6%, respectively.

After adjusting for baseline differences between people who died and those who did not, current smoking remained a significant independent risk factor for mortality, increasing the risk between four and fivefold depending on the comparator. Other independent risk factors for mortality were older age, chronic liver disease and severe sepsis, whereas influenza vaccine was protective.

Writing in Chest, Bello and co-authors say that current smokers admitted with CAP appear to be a distinct patient population, being much younger and with fewer comorbidities but worse health habits compared with non-current smokers.

“Our results reinforce that cigarette smoking is one of the strongest independent risk factor[s] for invasive pneumococcal disease among immunocompetent, nonelderly adults”, they write.

“Influenza vaccine appeared as an independent preventive factor for mortality in smokers, and this group should be considered as a target population for preventive strategies and firm cessation advice.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014

By Joanna Lyford, Senior medwireNews Reporter

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