Pneumonia: Complications

The following are the most important diseases or complications that may be contributed to by pneumonia (pneumonia):

Respiratory system (J00-J99)

  • Acute respiratory failure (“virus-induced respiratory failure”); lethality (mortality related to the total number of people suffering from the disease) up to 50%.
  • Lung abscess (accumulation of pus in the lungs) – sputum (sputum) stink putrid and is blood tinged
  • Pulmonary fibrosis (connective tissue remodeling of the lungs) – may result from chronic interstitial pneumonia.
  • Pleurisy (pleurisy).
  • Pleuraempyem (accumulation of pus in the pleural cavity).
  • Pleural effusion (fluid between the two sheets of the pleura/lung and pleura), parapneumonic (“around the lung”).
  • Pneumonia, chronic
  • Pneumothorax – collapse of the lung caused by an accumulation of air between the visceral pleura (lung pleura) and the parietal pleura (chest pleura).
  • Respiratory insufficiency (disorder of gas exchange of the lungs).
    • Respiratory partial insufficiency: arterial hypoxemia with reduction of partial pressure of oxygen below a threshold of 65-70 mmHg with normal to reduced carbon dioxide.
    • Respiratory global insufficiency: here is in addition to respiratory partial insufficiency hypercapnia (increase in carbon dioxide partial pressure > 45 mmHg).
  • Other sepsis (“blood poisoning”

Cardiovascular system (I00-I99)

  • Apoplexy* (stroke)
  • Endocarditis (meningitis of the heart)
  • Heart failure (cardiac insufficiency) – in 11.9% of CAP (community-acquired pneumonia) patients and in 7.4% of controls
  • Cardiovascular disease (coronary heart disease/coronary artery disease, apoplexy/stroke) – risk increased by a factor of 6 in the first year; by a factor of 2.47 and 2.12 in the second and third years; ≥ 5 years: increased by a factor of 1.87
  • Coronary artery disease* (CAD; coronary artery disease).
  • Myocardial infarction* (heart attack)
  • Pericarditis (inflammation of the pericardium)
  • Sudden cardiac death (PHT) – relative increase in risk in CAP patients:
    • <65 years of age: 1.98-fold.
    • > 65 years of age: 1.55-fold
  • Right heart failure (RHV) due to afterload increase.

Infectious and parasitic diseases (A00-B99).

  • Sepsis (blood poisoning; in invasive pneumococcal disease).

Musculoskeletal system and connective tissue (M00-M99).

Psyche – nervous system (F00-F99; G00-G99)

Symptoms and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99).

  • Systemic inflammatory response syndrome [SIRS] – life-threatening acute injury to the lungs; often with multiorgan failure.

* 30 days after hospital admission, a 4.07-fold increased risk; after 90 days, a 2.94-fold increased risk; and after 9 to 10 years, a 1.86-fold increased risk

Risk of need for intensive medical therapy for community-acquired pneumonia

Severe course of CAP, ie, acute emergency and immediate intensified management in a monitoring or intensive care unit. This is defined by the following criteria:

  • All patients with >2 minor criteria (see below) or.
  • With a major criterion (= invasive ventilation or systemic hypotension with vasopressor therapy).

Minor criteria are:

  • Severe acute respiratory failure (PaO2 ≤ 55 mmHg or ≤ 7 kPa on room air).
  • Respiratory rate ≥ 30/min
  • Multilobar infiltrates on chest radiography.
  • New-onset disturbance of consciousness
  • Systemic hypotension with need for aggressive volume therapy.
  • Acute renal failure (nitrogen content of urea ≥20 mg/dl).
  • Leukopenia (leukocytes <4,000 cells/mm3).
  • Thrombocytopenia (platelets < 100,000 cells/mm3)
  • Hypothermia (body temperature < 36 °C)

Prognostic factors

  • Increased mortality (death rate) in diabetics (2.47-fold increased mortality rate; type 1 diabetes five- to six-fold increased mortality rate, type 2 diabetics of both sexes 20% increased mortality rate)
  • Respiratory rate (norm: 12-18/min) on admission to hospital is an independent risk factor for hospital mortality in community-acquired pneumonia. Both decreased and increased respiratory rates on admission are associated with significantly increased hospital mortality. Other independent risk factors include age, admission from a nursing facility or rehabilitation facility, chronic bedriddenness, disorientation, pulse amplitude, and systolic blood pressure.