Existence and relevance of fulminant severe community-acquired pneumonia

Severe community-acquired pneumonia (sCAP) is a major contributor to global hospital mortality, with some patients rapidly progressing to death within a few days due to acute respiratory distress syndrome (ARDS), septic shock, or multiorgan failure (MOFS). Despite the significant health burden, these cases remain poorly defined, often overlooked in clinical practice, and insufficiently addressed in existing guidelines. In this multicenter retrospective study, we analyzed 1,517 hospitalized patients with sCAP for assessing the incidence of fulminant pneumonia -defined as sCAP leading to death within 7 days from hospital admission- and to identify factors associated with either an increased or reduced risk of unfavorable outcome. Our findings revealed a 5.9% incidence of fulminant pneumonia, with early death primarily due to ARDS (93%), sepsis (70%), and MOFS (73%). Older age, obesity, diabetes, cardiovascular disease, and elevated serum creatinine were associated with increased risk, while early corticosteroid administration was associated with a significant mortality reduction within seven days, both in the univariate and multivariate analyses (OR 0.22, CI 95% 0.12–0.38, p < 0.001). Baseline respiratory impairment and inflammatory markers were not associated with early mortality. These findings highlight the importance of recognizing sCAP as a time-dependent condition, requiring early identification and treatment of cases at risk for developing fulminant pneumonia at hospital admission. Larger studies and randomized controlled trials are necessary to validate these findings and optimize treatment strategies. ClinicalTrials.gov NCT06516601.

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Publication Details

Journal
Pneumonia
Published
2025-11-05
DOI
https://doi.org/10.1186/s41479-025-00180-0
Citations
1
Primary Topic
Pneumonia and Respiratory Infections
Type
article
Field-Weighted Citation Impact
1.35

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article

Existence and relevance of fulminant severe community-acquired pneumonia

Andrea Salotti, Giulia Barbati, Marco Confalonieri, Stefano Centanni et al.
1 citations
Pneumonia
Pneumonia and Respiratory Infections
1.35
article

Existence and relevance of fulminant severe community-acquired pneumonia

Andrea Salotti, Giulia Barbati, Marco Confalonieri, Stefano Centanni, Lina Pérez‐Méndez, Andrea Rocca, Barbara Ruaro, Paola Confalonieri, Umberto Zuccon, Cristina Fernández, Michele Mondoni, Francesco Salton, Sergio Harari, Domingo Antonio Sánchez Martínez, Francisco Alba, Alfonso Ambrós, Carlos Ferrando, Tomás Muñoz, Juan A. Soler, Jesús Villar, Stefano Gasparotto
article en
1 citations

Abstract

Severe community-acquired pneumonia (sCAP) is a major contributor to global hospital mortality, with some patients rapidly progressing to death within a few days due to acute respiratory distress syndrome (ARDS), septic shock, or multiorgan failure (MOFS). Despite the significant health burden, these cases remain poorly defined, often overlooked in clinical practice, and insufficiently addressed in existing guidelines. In this multicenter retrospective study, we analyzed 1,517 hospitalized patients with sCAP for assessing the incidence of fulminant pneumonia -defined as sCAP leading to death within 7 days from hospital admission- and to identify factors associated with either an increased or reduced risk of unfavorable outcome. Our findings revealed a 5.9% incidence of fulminant pneumonia, with early death primarily due to ARDS (93%), sepsis (70%), and MOFS (73%). Older age, obesity, diabetes, cardiovascular disease, and elevated serum creatinine were associated with increased risk, while early corticosteroid administration was associated with a significant mortality reduction within seven days, both in the univariate and multivariate analyses (OR 0.22, CI 95% 0.12–0.38, p < 0.001). Baseline respiratory impairment and inflammatory markers were not associated with early mortality. These findings highlight the importance of recognizing sCAP as a time-dependent condition, requiring early identification and treatment of cases at risk for developing fulminant pneumonia at hospital admission. Larger studies and randomized controlled trials are necessary to validate these findings and optimize treatment strategies. ClinicalTrials.gov NCT06516601.

PneumoniaVol. 17(1)
St. Michael's Hospital (CA), University of Trieste (IT), University of Milan (IT), Instituto de Salud Carlos III (ES), Hospital Universitario Nuestra Señora de Candelaria (ES), Hospital General Nuestra Señora del Prado (ES), MultiMedica (IT), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Azienda Ospedaliera Santa Maria Degli Angeli (IT), Ospedale San Paolo (IT), Hospital Clínic de Barcelona (ES), Hospital General Universitario de Ciudad Real (ES), Hospital de Cruces (ES), St Michael's Hospital (GB), Hospital Universitario Virgen de la Arrixaca (ES), Fundación Canaria de Investigación Sanitaria (ES)
Instituto de Salud Carlos III
Openalex Percentile: Top 14%
Pneumonia and Respiratory Infections
1.35
DOIOpen Access PDFOpenAlex
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