The Prognostic Significance of Respiratory Rate in Patients with Pneumonia: a Retrospective Analysis of Data from 705,928 Hospitalized Patients in Germany from 2010-2012

Overview

Journal Dtsch Arztebl Int

Specialties General Medicine
Public Health

Date 2014 Aug 22

PMID 25142073

Citations 38

Authors

Richard Strauss

Santiago Ewig

Klaus Richter

Thomas Konig

Gunther Heller

Torsten T Bauer

Affiliations

Soon will be listed here.

Abstract

Background: Measurement of the respiratory rate is an important instrument for assessing the severity of acute disease. The respiratory rate is often not measured in routine practice because its clinical utility is inadequately appreciated. In Germany, documentation of the respiratory rate is obligatory when a patient with pneumonia is hospitalized. This fact has enabled us to study the prognostic significance of the respiratory rate in reference to a large medical database.

Method: We retrospectively analyzed data from the external quality-assurance program for community-acquired pneumonia for the years 2010-2012. All patients aged 18 years or older who were not mechanically ventilated on admission were included in the analysis. Logistic regression was used to determine the significance of the respiratory rate as a risk factor for in-hospital mortality.

Results: 705,928 patients were admitted to the hospital with community-acquired pneumonia (incidence: 3.5 cases per 1000 adults per year). The in-hospital mortality of these patients was 13.1% (92 227 persons). The plot of mortality as a function of respiratory rate on admission was U-shaped and slanted to the right, with the lowest mortality at a respiratory rate of 20/min on admission. If patients with a respiratory rate of 12-20/min are used as a baseline for comparison, patients with a respiratory rate of 27-33/min had an odds ratio (OR) of 1.72 for in-hospital death, and those with a respiratory rate above 33/min had an OR of 2.55. Further independent risk factors for in-hospital death were age, admission from a nursing home, hospital, or rehabilitation facility, chronic bedridden state, disorientation, systolic blood pressure, and pulse pressure.

Conclusion: Respiratory rate is an independent risk marker for in-hospital mortality in community-acquired pneumonia. It should be measured when patients are admitted to the hospital with pneumonia and other acute conditions.

Citing Articles

Low compression smart clothing for respiratory rate monitoring using a bending angle sensor based on double-layer capacitance.

Kobayashi T, Goto D, Sakaue Y, Okada S, Shiozawa N Biomed Eng Lett. 2025; 15(2):389-399.

PMID: 40026894 PMC: 11871213. DOI: 10.1007/s13534-025-00456-w.

Development and validation of a mortality predictive model for ICU patients with primary pulmonary hypertension.

Zhang C, Hu Y, Meng Z, Lu C, Xie Y, Yu Q Sci Rep. 2024; 14(1):31497.

PMID: 39732999 PMC: 11682143. DOI: 10.1038/s41598-024-83139-3.

Respiratory-swallow patterning and oropharyngeal swallowing impairment in patients undergoing evaluation for lung transplant.

Graham K, Reedy E, Lee J, Norton E, Arunachalam A, Tomic R Neurogastroenterol Motil. 2024; 36(11):e14912.

PMID: 39223932 PMC: 11484915. DOI: 10.1111/nmo.14912.

Diagnosis and Therapy of Community-Acquired Pneumonia in the Emergency Department: A Retrospective Observational Study and Medical Audit.

Luthi-Corridori G, Roth A, Boesing M, Jaun F, Tarr P, Leuppi-Taegtmeyer A J Clin Med. 2024; 13(2).

PMID: 38276080 PMC: 10816545. DOI: 10.3390/jcm13020574.

Identifying vital sign trajectories to predict 28-day mortality of critically ill elderly patients with acute respiratory distress syndrome.

Li M, Liu F, Yang Y, Lao J, Yin C, Wu Y Respir Res. 2024; 25(1):8.

PMID: 38178157 PMC: 10765902. DOI: 10.1186/s12931-023-02643-8.

References

Gaucher A, Frasca D, Mimoz O, Debaene B . Accuracy of respiratory rate monitoring by capnometry using the Capnomask(R) in extubated patients receiving supplemental oxygen after surgery. Br J Anaesth. 2011; 108(2):316-20. DOI: 10.1093/bja/aer383. View

Fine M, Auble T, Yealy D, Hanusa B, Weissfeld L, Singer D . A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(4):243-50. DOI: 10.1056/NEJM199701233360402. View

Goldhill D, McNarry A, Mandersloot G, McGinley A . A physiologically-based early warning score for ward patients: the association between score and outcome. Anaesthesia. 2005; 60(6):547-53. DOI: 10.1111/j.1365-2044.2005.04186.x. View

Mandell L, Wunderink R, Anzueto A, Bartlett J, Campbell G, Dean N . Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. PMC: 7107997. DOI: 10.1086/511159. View

Di Martino P, Leoli F, Cinotti F, Virga A, Gatta L, Kleefield S . Improving vital sign documentation at triage: an emergency department quality improvement project. J Patient Saf. 2011; 7(1):26-9. DOI: 10.1097/PTS.0b013e31820c9895. View

Lim W, van der Eerden M, Laing R, Boersma W, Karalus N, Town G . Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003; 58(5):377-82. PMC: 1746657. DOI: 10.1136/thorax.58.5.377. View

Lim W, Carty S, Macfarlane J, Anthony R, Christian J, Dakin K . Respiratory rate measurement in adults--how reliable is it?. Respir Med. 2002; 96(1):31-3. DOI: 10.1053/rmed.2001.1203. View

McBride J, Knight D, Piper J, Smith G . Long-term effect of introducing an early warning score on respiratory rate charting on general wards. Resuscitation. 2005; 65(1):41-4. DOI: 10.1016/j.resuscitation.2004.10.015. View

Goldhill D, McNarry A . Physiological abnormalities in early warning scores are related to mortality in adult inpatients. Br J Anaesth. 2004; 92(6):882-4. DOI: 10.1093/bja/aeh113. View

10.

Goldhill D, Worthington L, Mulcahy A, Tarling M, Sumner A . The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia. 1999; 54(9):853-60. DOI: 10.1046/j.1365-2044.1999.00996.x. View

11.

Simoes E, Roark R, Berman S, Esler L, Murphy J . Respiratory rate: measurement of variability over time and accuracy at different counting periods. Arch Dis Child. 1991; 66(10):1199-203. PMC: 1793530. DOI: 10.1136/adc.66.10.1199. View

12.

McFadden J, Price R, Eastwood H, Briggs R . Raised respiratory rate in elderly patients: a valuable physical sign. Br Med J (Clin Res Ed). 1982; 284(6316):626-7. PMC: 1496225. DOI: 10.1136/bmj.284.6316.626. View

13.

Butler-Williams C, Cantrill N, Maton S . Increasing staff awareness of respiratory rate significance. Nurs Times. 2005; 101(27):35-7. View

14.

Hodgetts T, Kenward G, Vlachonikolis I, Payne S, Castle N . The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team. Resuscitation. 2002; 54(2):125-31. DOI: 10.1016/s0300-9572(02)00100-4. View

15.

Bleyer A, Vidya S, Russell G, Jones C, Sujata L, Daeihagh P . Longitudinal analysis of one million vital signs in patients in an academic medical center. Resuscitation. 2011; 82(11):1387-92. DOI: 10.1016/j.resuscitation.2011.06.033. View

16.

Fischl M, Pitchenik A, Gardner L . An index predicting relapse and need for hospitalization in patients with acute bronchial asthma. N Engl J Med. 1981; 305(14):783-9. DOI: 10.1056/NEJM198110013051402. View

17.

. Community-acquired pneumonia in adults in British hospitals in 1982-1983: a survey of aetiology, mortality, prognostic factors and outcome. The British Thoracic Society and the Public Health Laboratory Service. Q J Med. 1987; 62(239):195-220. View

18.

Subbe C, Davies R, Williams E, Rutherford P, Gemmell L . Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia. 2003; 58(8):797-802. DOI: 10.1046/j.1365-2044.2003.03258.x. View

19.

Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G . Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005; 365(9477):2091-7. DOI: 10.1016/S0140-6736(05)66733-5. View

20.

Hoffken G, Lorenz J, Kern W, Welte T, Bauer T, Dalhoff K . [Epidemiology, diagnosis, antimicrobial therapy and management of community-acquired pneumonia and lower respiratory tract infections in adults. Guidelines of the Paul-Ehrlich-Society for Chemotherapy, the German Respiratory Society, the German...]. Pneumologie. 2009; 63(10):e1-68. DOI: 10.1055/s-0029-1215037. View