Risk of mortality associated with antipsychotic and other neuropsychiatric drugs in pneumonia patients

Objective: To evaluate the use of typical and atypical antipsychotic medications and associated in-hospital mortality in a group of Veterans Administration (VA) patients with pneumonia. Method: Our cohort consisted of 14,057 VA patients admitted for pneumonia in fiscal year (FY) 2003. Exposure to typical and atypical antipsychotics and other neuropsychiatric drugs was based on a prescription within 120 days preceding admission. Multivariate models determined the odds of mortality associated with each drug class and risk adjusted for comorbidity, admission source, demographic factors, and concurrent mental health conditions. The referent group for each analysis was pneumonia patients not receiving neuropsychiatric drugs. Results: In adjusted analyses, the odds of in-hospital mortality for VA patients admitted with pneumonia was higher for recent exposure to typical antipsychotics (OR = 1.5 1, 95% CI = 1.042.19; P = 0.03) when compared to patients not receiving neuropsychiatric medications. Patients exposed to atypical antipsychotics (OR = 1.20, 95% CI = 0.96-1.50, P =.10), tri-cyclic antidepressants (OR=1.20, 95% CI = 0.44-1.55; P = 0.15), other antidepressants (OR = 1.07 95% CI 0.93- 1.23; P = 0.37) or mood stabilizers (OR=0.91, 95% CI= 0.73-1.14; P= 0.41) had no significant difference in in-hospital mortality. Conclusion: In spite of recent safety concerns for atypical antipsychotics, we found no increased risk of mortality in acutely ill pneumonia patients. Rather, we found a higher adjusted mortality rate for patients taking typical antipsychotics. The contrasting mortality risks for patients taking typical and atypical antipsychotics may represent unmeasured severity of illness or comorbidity. Regardless, any antipsychotics should be used with caution and the efficacy and safety of alternative agents should be considered.