Mortality from community-acquired pneumonia: prevalence at Loma Pyta Hospital

INTRODUCTION

Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality worldwide, particularly in low- and middle-income countries. (1) Despite advances in diagnosis, treatment, and vaccination, it continues to represent a significant burden on public health systems, especially among vulnerable populations such as older adults and individuals with comorbidities. (2,3)

CAP is defined as an acute respiratory infection acquired outside the hospital setting or within the first 48 hours of hospital admission. (4) The most common etiological agents include Streptococcus pneumoniae, Haemophilus influenzae, and atypical pathogens such as Mycoplasma pneumoniae and Chlamydia pneumoniae. (5) Its incidence and outcomes vary across regions, influenced by factors such as access to healthcare, vaccination coverage, socioeconomic conditions, and underlying diseases. (6,7)

In Paraguay, acute respiratory infections particularly pneumonia remain among the leading causes of hospitalization and mortality, especially in older adults and other high-risk groups. (6,7) However, although CAP is a well-recognized public health problem in the country, there is a lack of updated and detailed information on the clinical and sociodemographic characteristics of patients who die from CAP, particularly in specific hospital settings. (8,9)

The Loma Pyta Maternal and Child Hospital is a regional reference center that serves a large population; nevertheless, it lacks systematic and recent studies focused on fatal cases of CAP and their associated clinical profiles. (10,11) Diagnosis is based on clinical signs and symptoms, physical examination, and chest X-ray (posterior-anterior and lateral views). (12) The systemic inflammatory response underlies the clinical findings and may involve multiple organ systems, while treatment aims to eradicate the causative agent and prevent complications such as sepsis, considering etiology, comorbidities, and risk stratification. (13)

The absence of updated local information limits the design of effective prevention and management strategies. (14)

Therefore, this study aimed to describe the clinical and sociodemographic characteristics of older adults who died from community-acquired pneumonia and to identify factors potentially associated with these outcomes in patients admitted to the Loma Pyta Maternal and Child Hospital during 2024, providing evidence to strengthen epidemiological surveillance, guide health policies, and optimize the quality of care for patients with respiratory infections. (15)

METHODS

This was a retrospective, observational, descriptive, cross-sectional study conducted during 2024 at the Loma Pyta Maternal and Child Hospital. During the study period, a total of 209 patients were admitted with a diagnosis of community-acquired pneumonia (CAP), of whom 43 died, constituting the study population.

A non-probabilistic convenience sample was used, including all eligible deceased patients who met the selection criteria. Data were obtained from medical records completed by the attending physicians.

The study variables included sociodemographic characteristics (age, sex, educational level, occupation, area of residence), clinical features (comorbidities, signs and symptoms), associated factors (delay in treatment initiation, access to intensive care, advanced age), and hospital stay (length of hospitalization in days).

Inclusion criteria: Complete and legible medical records of patients admitted to the Loma Pyta Maternal and Child Hospital with a diagnosis of CAP, who died between January and December 2024.

Exclusion criteria: Medical records lacking essential information or patients who were not hospitalized despite having a CAP diagnosis during the study period.

Data analysis: Data were analyzed using descriptive statistics. Categorical variables were expressed as frequencies and percentages, while quantitative variables were summarized using measures of central tendency (mean and/or median) and dispersion (standard deviation and/or interquartile range), according to data distribution.

Ethical considerations: The study complied with the ethical principles of the Declaration of Helsinki. Approval was obtained from the Ethics Committee of the Loma Pyta Maternal and Child Hospital (or corresponding institutional review board), prior to data collection.

Patient anonymity, confidentiality, and data privacy were strictly maintained throughout the study, and no identifying information was recorded.

RESULTS

A total of 43 patients diagnosed with community-acquired pneumonia were included in this study at the Loma Pyta Maternal and Child Hospital.

Source: HMILP Statistics Department

The distribution of deaths by age showed a predominance in older age groups. Patients aged ≥70 years accounted for 58.1 % of cases, compared to 41.9 % in those aged <70 years. Females represented the majority of deaths (65.1%), while males accounted for 34.9%. Regarding educational level, most patients had low educational attainment (primary or secondary education: 90.7 %), whereas only 9.3 % had higher education. In terms of occupation, retirees constituted the largest group (44.2 %), followed by housewives (18.6 %) and informal workers (14 %). All patients resided in urban areas.

.

Source: HMILP Statistics Department.

Among comorbidities, hypertension was the most frequent (30.2 %), followed by diabetes mellitus (14 %) and chronic obstructive pulmonary disease (9.3 %). When grouped, cardiometabolic conditions (hypertension and diabetes) were present in 44.2 % of patients, suggesting a high burden of chronic disease. The most common symptoms were cough (88.4 %) and fever (79.1%), followed by crackles (65.1 %) and dyspnea (55.8 %). Indicators of clinical severity, such as tachypnea (48.8 %) and low oxygen saturation (32.6 %), were also frequently observed.

Source: HMILP Statistics Department.

A delay in treatment initiation was identified in most cases. Patients who started treatment ≥6 days after symptom onset represented 76.7 % of the sample, compared to 23.3 % who initiated treatment within 5 days. Access to intensive care was limited: 88.4 % of patients did not receive ICU care, while only 11.6 % had access. When stratified by age, patients aged ≥71 years accounted for 58.1 % of deaths, reinforcing the association between advanced age and mortality.

Source: HMILP Statistics Department.

Most patients had hospital stays between 5 and 7 days (41.9 %), followed by 8–12 days (34.9 %) and 13–15 days (16.3 %). Stays longer than 15 days were less frequent (7.0 %). When grouped, 76.8 % of patients remained hospitalized between 5 and 12 days, indicating a relatively consistent hospitalization pattern among fatal cases.

DISCUSSION

This study identified a high case fatality rate (20.6 %) among patients hospitalized with community-acquired pneumonia (CAP), predominantly affecting older adults, with a high burden of comorbidities, delayed initiation of treatment, and limited access to intensive care. ⁽¹⁵⁾ These findings highlight multiple interacting factors that may contribute to poor outcomes in this population.

Age emerged as a key determinant of mortality, with most deaths occurring in patients aged ≥70 years. ⁽³˒¹⁶⁾ This finding reflects the increased biological vulnerability associated with aging, including immunosenescence, reduced physiological reserve, and a higher prevalence of chronic diseases. The predominance of female patients may be explained by demographic patterns such as greater life expectancy among women rather than a direct association with mortality risk.

The high prevalence of comorbidities, particularly hypertension and diabetes mellitus, underscores their role as contributors to disease severity and mortality. ⁽³,¹⁶⁾ These conditions may worsen outcomes by impairing immune response and increasing susceptibility to complications such as respiratory failure and sepsis. The coexistence of cardiometabolic diseases suggests a cumulative negative effect on prognosis. ⁽¹⁹,²⁰⁾

One of the most relevant findings was the delay in treatment initiation, with most patients receiving therapy after six days of symptom onset. This delay is clinically significant, as early antibiotic treatment is associated with improved survival in CAP. ⁽¹³⁾ Possible explanations include delayed healthcare-seeking behavior, barriers to access, or limitations in early diagnosis. This finding contrasts with clinical recommendations and may partially explain the elevated mortality observed.

Limited access to intensive care was another critical factor, with most patients not receiving ICU support. This aspect is particularly important considering the study setting in a maternal and child hospital. Such institutions are primarily oriented toward pediatric and obstetric care, which may limit the availability of adult critical care resources. This structural constraint could have directly influenced outcomes, especially in patients requiring advanced support. ⁽¹⁰,¹¹⁾

The observed length of hospital stays, predominantly between 5 and 12 days, suggests a relatively rapid progression of disease leading to death. This may indicate late presentation or advanced disease at admission. While some studies report longer hospital stays associated with complications, ⁽²¹⁾ the shorter duration observed here may reflect early mortality rather than recovery.

Although many findings are consistent with studies conducted in Latin America, ⁽¹⁷⁻²⁰⁾ differences such as the markedly limited ICU access highlight the importance of local healthcare structure in shaping outcomes. These discrepancies reinforce the need to interpret results within the specific institutional and regional context.

Limitations of the study

This study has several important limitations. First, its retrospective and cross-sectional design limits the ability to establish causal relationships. Second, the small sample size (n=43) reduces statistical power and limits generalizability. Third, the study was conducted in a single center, specifically a maternal and child hospital, which may not represent other healthcare settings.

Additionally, the use of secondary data from medical records may have introduced information bias due to incomplete documentation. Finally, the absence of a comparison group limits the identification of independent risk factors through analytical methods.

CONCLUSION

This study demonstrated that community-acquired pneumonia at Loma Pyta Hospital mainly affected elderly patients aged 71–89 years, predominantly female, with primary education. Most began treatment late—between 6 and more than 7 days after symptom onset—which likely influenced clinical outcomes. Access to intensive care was limited, and most patients remained hospitalized for 8–12 days, reflecting the complexity of managing this condition in elderly populations.

The study’s limitations included incomplete data in some records and missing relevant variables, which restricted deeper analysis. These findings emphasize the need to strengthen primary care, accelerate diagnosis, and ensure timely access to treatment to improve outcomes and reduce CAP-related morbidity and mortality. It is recommended to reinforce early detection, guarantee timely treatment, enhance access to specialized care, and maintain comprehensive patient records for better internal evaluation and clinical management.

Author Contribution Statement

Regarding the research “Community-Acquired Pneumonia Mortality: Prevalence at the Loma Pyta Maternal and Child Hospital,” the authors declare the following contributions:

EUL: Study design, conceptualization, manuscript drafting, and overall research management.

GAS: Manuscript typing, translation, and general revision of the document.

GMNS: Data collection and analysis of medical records provided by the hospital.

TMGS: Preparation of tables, figures, and graphical data presentation.

LMWF: Critical revision of the manuscript (initial and final versions), participation in discussion, editing, and academic supervision.

References

1. 1 Marecos M, Jiménez HJ, Duarte L, Martínez de Cuellar C. Características clínicas y factores de riesgo asociados a severidad de la neumonía adquirida de la comunidad en ≤ 17 años hospitalizados. Pediatr (Asunción). 2025;52(1):8. doi:10.31698/ped.52012025008
2. 2 Montiel DE, Jarolin M, Núñez P, López Ibarra F. Características clínicas y mortalidad de pacientes con Neumonía Adquirida en la Comunidad en el Hospital Nacional de Itauguá. Rev Cient Cienc Salud. 2020;2(1):44–53. doi:10.53732/rccsalud/02.01.2020.66
3. 3 Gómez Venialgo P, Torales Montiel J, Ferreira Mendieta F, Jara Rossi S, Ortega Filartiga E. Frecuencia y características clínicas de las neumonías adquiridas en la comunidad que requieren hospitalización. Rev Cient Cienc Salud. 2020;2(1):27–34. doi:10.53732/rccsalud/02.01.2020.27
4. 4 Mussi BM, Mendes KF, Centella K. Neumonía Adquirida en Comunidad, un relato de caso en el Hospital Regional “Dr. Aníbal Leoncio Medina Valiente” de Pedro Juan Caballero. Rev MEDUCP. 2021;1(1):83–84. doi:10.59085/2789-7818.2021.9
5. 5 Martínez RI. Perfil clínico y epidemiológico de la neumonía adquirida en la comunidad en menores de 5 años en el servicio de pediatría del Hospital Regional de Coronel Oviedo, 2021–2023 [Tesis]. Facultad de Ciencias Médicas, Universidad Nacional de Caaguazú; 2023. Disponible en: https://repositorio.fcmunca.edu.py/xmlui/handle/123456789/342
6. 6 España Yandiola P, Capelastegui A. Neumonía adquirida en la comunidad de carácter grave: valoración y predicción. Rev Virtual Soc Parag Med Interna. 2016;3(2):7–17.
7. 7 Gentilotti E, De Nardo P, Cremonini E, et al. Diagnostic accuracy of point-of-care tests in acute community-acquired lower respiratory tract infections: A systematic review and meta-analysis. Clin Microbiol Infect. 2022;28(1):13–22. doi:10.1016/j.cmi.2021.09.025
8. 8 Guan X, Gao S, Zhao H, et al. Clinical characteristics of hospitalized term and preterm infants with community-acquired viral pneumonia. BMC Pediatr. 2022;22:452. doi:10.1186/s12887-022-03508-7
9. 9 Ma R, Liu Z, Zhang L, et al. Epidemiological characteristics of severe community-acquired pneumonia in children admitted to two tertiary hospitals in Shihezi, Xinjiang Region, China in 2023: a cross-sectional analysis. J Thorac Dis. 2024;16(10):6969–6982. doi:10.21037/jtd-24-1417
10. 10 Mao S, Wu L. Coinfection of viruses in children with community-acquired pneumonia. BMC Pediatr. 2024;24:457. doi:10.1186/s12887-024-04939-0
11. 11 Alves PHPS, Silva DGM, Rocha LO, Dias DD, Barbosa PBP, Gomes AM. Pneumonia adquirida na comunidade e pneumonia associada à ventilação mecânica: uma análise abrangente da fisiopatologia, anatomia patológica, etiologia, epidemiologia, manifestações clínicas, diagnóstico, tratamento e desafios prognósticos. Cad. Pedagóg. [Internet]. 2024;21(2):e103. doi:10.54033/cadpedv21n2-103
12. 12 Gomes M. Pneumonia adquirida na comunidade: os desafios da realidade brasileira. J Bras Pneumol. 2018;44(6):473–4. doi:10.1590/S1806-37562018000040002
13. 13 Farias JA, Barros GA, Franco PB, Souza JF. Implementação de uma diretriz para pneumonia adquirida na comunidade em um hospital público no Brasil. J Bras Pneumol. 2009;35(8):753–9. doi:10.1590/S1806-37132009000800006
14. 14 Rabello L, Bozza FA, Soares M, Salluh JIF. Tratamento da pneumonia grave adquirida na comunidade no Brasil: análise secundária de um inquérito internacional. Rev Bras Ter Intensiva. 2015;27(1):31–8. doi:10.5935/0103-507X.20150010
15. 15 Mariano JPAV, Silva ARA, Lima FB, Ribeiro RCD, Cunha RM. Pneumonia adquirida na comunidade. Rev Cient Multidiscipl Núcleo do Conhecimento. 2022;8(4):121–38. doi:10.37885/221010520
16. 16 Mosquera-Rojas M, Rodríguez-Morales AJ, García-Morales C, et al. Prevalencia y factores asociados con la admisión a la unidad de cuidados intensivos en pacientes con neumonía adquirida en la comunidad. Med Intensiva. 2023;47(3):e1-e8. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11138820/
17. 17 Aramburu MI, González-Moreno M, Rodríguez-Morales AJ, et al. Epidemiología de la neumonía adquirida en la comunidad en adultos mayores en un hospital de Lima, Perú. Revista Peruana de Medicina Experimental y Salud Pública. 2013;30(1):1-7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985529/
18. 18 Julián-Jiménez A, García-González J, González-Moreno M, et al. Recomendaciones para la atención del paciente con neumonía adquirida en la comunidad en servicios de urgencias hospitalarios. Revista Cubana de Medicina Intensiva y Emergencias. 2018;17(1):1-9. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159381/
19. 19 Taboada LB, Díaz-Granados N, Rodríguez-Morales AJ, et al. Etiología de la neumonía adquirida en la comunidad en un hospital de Lima, Perú. Revista Peruana de Medicina Experimental y Salud Pública. 2015;32(1):1-7. Disponible en: https://www.sciencedirect.com/science/article/pii/S0123939214000691
20. 20 León-Pallasco DA, Rodríguez-Morales AJ, García-Morales C, et al. Actualización del manejo hospitalario de la neumonía adquirida en la comunidad en adultos mayores. Revista Cubana de Medicina Intensiva y Emergencias. 2023;32(1):1-8. Disponible en: https://www.scielo.sld.cu/scielo.php?pid=S1561-31942023000800034&script=sci_arttext
21. 21 Santos SR, Oliveira AC, Barros GM, Rodrigues RM. Length of hospital stay and associated factors in patients with community-acquired pneumonia. J Bras Pneumol. 2021;47(5):e20210120. doi:10.36416/1806-3756/e20210120