Predictors of Treatment Failure in Hospitalized Patients With Community-Acquired Pneumonia: A Prospective Cohort Study

BackgroundFailure to respond to treatment in a hospital is an important clinical issue that is related to worsening of the illness, length of hospital stay, intensive care unit admission, and death in patients with communityacquired pneumonia. ObjectiveThis study aimed to identify the independent demographic, clinical, laboratory, radiological, microbiological, and initial treatment-related predictors of treatment failure among hospitalized adults with community-acquired pneumonia. MethodologyThis was a prospective observational cohort study performed in the Pulmonology Department of Medical Teaching Institute (MTI)-Hayatabad Medical Complex in Peshawar, Pakistan, from July 2024 to June 2026.A total of 650 consecutive community-acquired pneumonia adult admissions were enrolled and followed up prospectively from admission to discharge or death.The failure of treatment was based on predefined clinical, respiratory, hemodynamic, radiological, and outcome-based criteria.Baseline information included demographic, clinical, laboratory, radiological, microbiological, and first treatment features.Univariable and multivariable logistic regression analyses were used to look for independent predictors of treatment failure. ResultsAmong 650 patients, treatment failure occurred in 98 (15.1%), comprising 61 (62.2%) early failures and 37 (37.8%) late failures.Patients with treatment failure were more likely to be older and to have chronic liver disease, altered mental status, impaired oxygenation, leukopenia, elevated inflammatory markers, multilobar pneumonia, and pleural effusion.On multivariable analysis, independent predictors included age ≥65 years (adjusted odds ratio (aOR): 1.71), chronic liver disease (aOR: 2.31), altered mental status (aOR: 1.88), oxygen saturation <90% (aOR: 2.37), CURB-65 ≥3 (aOR: 2.42), leukopenia (aOR: 1.89), C-reactive protein (CRP) >100 (aOR: 1.69), multilobar involvement (aOR: 1.91), and pleural effusion (aOR: 1.76). ConclusionRecognition of these baseline clinical, physiological, inflammatory, and radiological characteristics may help identify patients requiring closer monitoring and early reassessment during hospitalization.