Do-not-resuscitate orders in patients with community-acquired pneumonia: a retrospective study
Open accessAbstract
Background: To investigate the use of do-not-resuscitate (DNR) orders in patients hospitalized with community-acquired pneumonia (CAP) and the association with mortality. Methods: We assembled a cohort of 1317 adults hospitalized with radiographically confirmed CAP in three Danish hospitals. Patients were grouped into no DNR order, early DNR order (≤48 h after admission), and late DNR order (> 48 h after admission). We tested for associations between a DNR order and mortality using a cox proportional hazard model adjusted for patient and disease related factors. Results: Among 1317 patients 177 (13%) patients received a DNR order: 107 (8%) early and 70 (5%) late, during admission. Patients with a DNR order were older (82 years vs. 70 years, p < 0.001), more frequently nursing home residents (41% vs. 6%, p < 0.001) and had more comorbidities (one or more comorbidities: 73% vs. 59%, p < 0.001). The 30-day mortality was 62% and 4% in patients with and without a DNR order, respectively. DNR orders were associated with increased risk of 30-day mortality after adjustment for age, nursing home residency and comorbidities. The association was modified by the CURB-65 score Hazard ratio (HR) 39.3 (95% CI 13.9–110.6), HR 24.0 (95% CI 11.9–48,3) and HR 9.4 (95% CI: 4.7–18.6) for CURB-65 score 0–1, 2 and 3–5, respectively. Conclusion: In this representative Danish cohort, 13% of patients hospitalized with CAP received a DNR order. DNR orders were associated with higher mortality after adjustment for clinical risk factors. Thus, we encourage researcher to take DNR orders into account as potential confounder when reporting CAP associated mortality.
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The findings suggest a higher rate of DNACPR use (31%) than identified in previous studies of other respiratory conditions or sepsis.
“Our findings suggest a higher rate of DNACPR use (31%) than identified in previous studies of other respiratory conditions or sepsis.”
From Do not attempt cardiopulmonary resuscitation (DNACPR) decisions in people admitted with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study (2021) · cites this paper as [6]
The Results report DNR orders in 13% of patients hospitalized with community-acquired pneumonia, a respiratory condition, and the Discussion cites other pneumonia rates below 31%. The paper mentions septic shock but gives no DNR-use rate for sepsis, so it supports the respiratory-condition comparison but not the sepsis comparison. The 31% figure is the citing authors’ own finding, not a result attributed to this source. (LLM, conf=0.85)
Experimental — accuracy not yet measuredStudies of patients admitted with community-acquired pneumonia reported rates of DNACPR use ranging from 13% to 29%.
“Studies of patients admitted with community-acquired pneumonia reported rates of DNACPR use ranging from 13% to 29%,6, 7, 8, 9, 10”
Previous studies have estimated the prevalence of DNACPR decision in patients admitted to hospital with community-acquired pneumonia and sepsis, and have attempted to identify factors associated with DNACPR use, but we currently know very little about how DNACPR decisions have been used in people admitted with suspected COVID-19.
“Previous studies have estimated the prevalence of DNACPR decision in patients admitted to hospital with community-acquired pneumonia6, 7, 8, 9, 10 and sepsis,11, 12, 13, 14 and have attempted to identify factors associated with DNACPR use, but we currently know very little about how DNACPR decisions have been used in people admitted with suspected COVID-19.”
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- Authors
- Egelund, G. B., Jensen, A. V., Petersen, P. T., Andersen, S. B., Lindhardt, B. Ø., Rohde, G., Ravn, P., & von Plessen, C.
- Affiliations
- University of Copenhagen (DK)
- Nordsjællands Hospital (DK)
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Egelund, Gertrud Baunbæk
- Jensen, Andreas Vestergaard
- ORCID
- Venue
- BMC Pulmonary Medicine
- Published
- 2020-07-24
- Volume
- 20
- Issue
- 1
- Pages
- 201-201
- ISSN
- 1471-2466 (ISSN-L)
- PMC
- PMC7379759
- OpenAlex
- W3045005105
- Cited by
- 15
- References
- 27
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 2
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Pulmonary Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Forskningsrådet, Nordsjællands Hospital
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- do-not-resuscitate orders, community-acquired pneumonia, 30-day mortality, CURB-65 score, nursing home residents, comorbidities, end-of-life decisions, hospitalized patients
- MeSH terms
- Aged, Aged, 80 and over, Denmark, Female, Humans, Male, Pneumonia, Retrospective Studies, Risk, Time Factors, Comorbidity, Proportional Hazards Models, Resuscitation Orders, Treatment Outcome, Hospital Mortality, Community-Acquired Infections
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