Mortensen EM (VERDICT), Copeland LA
(VERDICT), Restrepo MI
(VERDICT), Pugh MJ
(VERDICT), Nakashima B
(VERDICT), Anzueto A
(South Texas Veterans Health Care System)
Many physicians recommend that patients receive follow-up chest imaging after the diagnosis of pneumonia to ensure that a pulmonary malignancy is not missed. There is little research evidence to support this practice. The aims of this study were to assess the frequency of the diagnosis of pulmonary malignancy, either primary or metastasis, after hospitalization for community-acquired pneumonia (CAP), and to identify risk factors for post-hospitalization pulmonary malignancy.
We conducted a retrospective national cohort study using Department of Veterans Affairs administrative data including subjects > 65 years hospitalized with a discharge ICD-9 diagnosis of CAP in fiscal years 2002-2007 and having at least one year of Veterans Affairs outpatient care prior to index admission. The primary outcome was the incidence of a new diagnosis of cancer involving the lungs or respiratory tract excluding those with these diagnoses prior to their hospitalization for CAP. Statistical significance was set at p < 0.001.
We identified 66,351 patients who were hospitalized with CAP during the study period. Of these, 7,745 (12%) patients had a diagnosis of pulmonary malignancy prior to hospitalization, and an additional 4,137 (6.3%) patients were diagnosed after hospitalization for CAP. Factors significantly associated with post-CAP hospitalization pulmonary malignancy included history of chronic pulmonary disease, younger age, being married, white (not Hispanic) race, and not having required intensive care unit care during their hospitalization. Having a history of certain comorbid conditions was associated with a lower incidence of diagnosis including congestive heart failure, stroke, dementia, and diabetes.
A small, but clinically important, number of patients are diagnosed with pulmonary malignancy post-hospitalization for CAP. The association of pulmonary malignancy with younger age is notable.
Follow-up chest imaging is important for those previously hospitalized with CAP, especially for those at higher risk for malignancy. Further research is needed to identify appropriate timing for this imaging and ideal imaging modalities.