(1129) Hospital Outcomes in Acute Respiratory Distress Syndrome After Community-Acquired Pneumonia

Introduction: Community-acquired pneumonia (CAP) is a risk factor for acute respiratory distress syndrome (ARDS), and both conditions are associated with significant disease burden and health care consumption. However, there is limited prior research assessing whether development of ARDS after CAP impacts patient outcomes. In this study of patients hospitalized with CAP, we investigated inpatient outcomes between patients who did and did not develop ARDS.

Methods: This is a retrospective study using the Premier Healthcare Database between 2016 and 2020. Patients diagnosed with CAP who required mechanical ventilation (MV), antimicrobial therapy, and hospital admission of at least 2 days were included. Patients were divided into two cohorts: those who did and did not develop ARDS after CAP. Multivariable regression models were used to compare differences in outcomes between cohorts, including in-hospital mortality, hospital length of stay (LOS), ICU LOS, days on MV, and total hospitalization cost.

Results: 1,924 (2.7%) of 72,107 CAP patients developed ARDS. ARDS was associated with higher mortality (33.7% vs. 18.9%; odds ratio (OR) 2.4; 95% CI 2.16-2.66), longer hospital LOS (13 vs. 9 days; incidence risk ratio (IRR) 1.24; 95% CI 1.20-1.27), ICU LOS (9 vs. 5 days; IRR 1.51; 95% CI 1.46-1.56), more MV days (8 vs. 5; IRR 1.54; 95% CI 1.48-1.59), and increased hospitalization cost ($46,459 vs. $29,441; IRR 1.50; 95% CI 1.45-1.55).

Conclusions: In CAP, ARDS was associated with worse inpatient outcomes in terms of mortality, length of stay, duration of mechanical ventilation, and hospitalization cost. This has implications for the prognosis of two prevalent and serious pulmonary diseases. Future studies are needed to explore outcomes in CAP patients with ARDS and explore risk factors for development of ARDS after CAP.