Characteristics and Factors Associated with Unfavorable Outcomes Among Adult Patients Admitted with Community-Acquired Pneumonia

Background: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality in sub-Saharan Africa. Understanding local patient characteristics and prognostic factors is essential for improved clinical outcomes. This study sought to identify characteristics and factors associated with unfavourable outcomes among adult inpatients with CAP. Methods: A prospective cohort study of 350 consecutively-sampled adult inpatients admitted with CAP conducted over six months. Primary outcome was composite (all-cause in-hospital mortality, need for ICU admission, prolonged stay ≥10 days or/and complications). Multivariable logistic regression identified independent predictors. Results: The composite unfavorable outcome rate was 53.4%, comprising in-hospital mortality (22.0%), prolonged hospital stay (30.0%), need for ICU admission (17.4%) and complications (2.9%). Altered mental status (aOR 1.71; 95% CI 1.03–2.83) and hypotension (aOR 2.89; 95% CI 1.34–6.23) independently predicted composite unfavourable outcome. Only 18% of patients requiring intensive care were admitted to the ICU. Conclusion: More than half of adults admitted with CAP experienced an unfavourable outcome; with altered mental status and hypotension emerging as the most consistent independent predictors. These findings, together with the marked gap between ICU need and ICU access, underscore the multifactorial, severity-driven nature of poor CAP outcomes in this setting and the influence of constrained critical-care capacity.