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Title: Tobacco smoking increases the risk for death from pneumococcal pneumonia
Authors: Bello, Salvador
Menéndez, Rosario
Torres, Antoni
Reyes, Soledad
Zalacain, Rafael
Capelastegui, Alberto
Aspa, Javier
Borderías, Luis
Martin-Villasclaras, Juan J.
Alfageme, Immaculada
De Castro, Felipe Rodríguez 
Rello, Jordi
Molinos, Luis
Ruiz-Manzano, Juan
UNESCO Clasification: 32 Ciencias médicas
3205 Medicina interna
320508 Enfermedades pulmonares
Keywords: Community-acquired pneumonia
Respiratory rate
Valent pneumococcal polysaccharide vaccine
Issue Date: 2014
Journal: Chest (American College of Chest Physicians) 
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 after 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 often 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.
ISSN: 0012-3692
DOI: 10.1378/chest.13-2853
Source: Chest [ISSN 0012-3692],v. 146, p. 1029-1037
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