Does prolonged onset of symptoms have a prognostic significance in community-acquired pneumonia?

Francisco Sanz, Marcos I. Restrepo, Estrella Fernández-Fabrellas, Ángela Cervera, María Luisa Briones, Laura Novella, María Carmen Aguar, Eusebi Chiner, Juan F. Fernandez, José Blanquer

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background and objective: Severity assessment is made at the time of the initial clinical presentation in patients with community-acquired pneumonia (CAP). It is unclear how the gap between time of presentation and duration of symptoms onset may impact clinical outcomes. Here we evaluate the association of prolonged onset of symptoms (POS) and the impact on clinical outcomes among hospitalized patients with CAP. Methods: This was a prospective, multicentre study of CAP in Spain. The primary outcomes were the clinical factors associated with POS defined as days from symptoms onset to pneumonia diagnosis > 7 days. The secondary outcomes were intensive care unit (ICU) admission, the presence of suppurative complications, septic shock and 30-day mortality. Results: We enrolled 1038 patients diagnosed of CAP: 152 (14.6%) patients had a POS. In multivariate analysis, the presence of prior corticosteroid therapy, alcohol abuse, prior antibiotic therapy, and confusion, urea, respiratory rate, blood pressure and age 65 years or older score 0-1 was independently associated with POS. Patients with POS had a higher incidence of suppurative complications, but not of 30-day mortality when compared with a shorter onset of symptoms. Conclusions: Approximately 15% of patients diagnosed with CAP had POS. Risk factors associated with POS were previous corticosteroids and antibiotic therapy, alcoholism and less severe pneumonia. POS was associated with a higher rate of suppurative complications and less need for ICU admission.

Original languageEnglish (US)
Pages (from-to)1073-1079
Number of pages7
JournalInternational Journal of Tourism Research
Issue number7
StatePublished - 2014


  • Antibiotic
  • Community-acquired pneumonia
  • Complication
  • Outcome
  • Risk factor

ASJC Scopus subject areas

  • Geography, Planning and Development
  • Nature and Landscape Conservation
  • Transportation
  • Tourism, Leisure and Hospitality Management


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