An investigation of multimorbidity measures as risk factors for pneumonia in elderly frail patients admitted to hospital

Ticinesi, Andrea; Nouvenne, Antonio; Folesani, Giuseppina; Prati, Beatrice; Morelli, Ivano; Guida, Loredana; Lauretani, Fulvio; Maggio, Marcello; Meschi, Tiziana

doi:10.1016/j.ejim.2015.11.021

Cited by 24 publications

(26 citation statements)

References 35 publications

(36 reference statements)

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“…However, the difference was no longer significant after adjustment for co-variates. The literature is consistent in showing that COPD is a risk factor for CAP, 5,9 and that this risk increases with the severity of the COPD. 8 What is not as clear is the impact of COPD on the outcomes of patients with CAP.…”

Section: Discussionsupporting

confidence: 71%

“…8 In a study on elderly patients with CAP, COPD and dementia were considered independent risk factors for admission. 9 In a different study, the most important factors contributing to higher mortality in patients with COPD and CAP admitted to the intensive care unit (ICU) were the presence of bilateral lung infiltrates and prolonged mechanical ventilation, while systemic corticosteroid use and shorter length of ICU stay seemed to be protective against a fatal outcome. 10 Disease severity is also independently associated with worse outcomes, increasing mortality and complication rates.…”

Section: Introductionmentioning

confidence: 99%

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The presence of COPD does not influence clinical outcomes in hospitalized patients with community-acquired pneumonia.

Silva¹,

Gearhart²,

Maciel³

et al. 2017

JRI

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Introduction: Community acquired pneumonia (CAP) is a leading cause of death worldwide. Chronic obstructive pulmonary disease (COPD) is a well-established risk factor for development of CAP. What is not as clear is the impact of COPD on the outcomes of patients with CAP. In this study, we compared the outcomes of CAP in COPD and non-COPD patients. Methods: This was a retrospective cohort study. We conducted an analysis of the CommunityAcquired Pneumonia Organization (CAPO) international cohort study database, which includes patients with CAP admitted to several hospitals throughout the world. Patients were categorized into two groups based on the status of COPD: COPD positive or negative. Outcomes were time to clinical stability, length of hospital stay, and in-hospital mortality. Regression models were used to assess the independent effect of COPD on the outcomes. Results: This study included 7,325 patients. Of these, 1,869 (25.5%) had COPD. Patients with COPD had higher severity of illness (pneumonia severity index class V: 15% vs 9%; P <0.001). Accelerated failure time models with adjustment for co-variates showed no significant difference in the probability of clinical stability (P = 0.451) and of discharge (P = 0.232) in COPD vs. non-COPD patients. There was no difference in the crude in-hospital mortality between COPD and non-COPD patients (9% vs 9%; P = 0.37). Conclusion: Our study results show that COPD should not be considered a risk factor for poor outcomes in hospitalized patients with CAP.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

The presence of COPD does not influence clinical outcomes in hospitalized patients with community-acquired pneumonia.

Silva¹,

Gearhart²,

Maciel³

et al. 2017

JRI

View full text Add to dashboard Cite

show abstract

“…The incidence of community-acquired pneumonia (CAP) requiring hospitalisation is 1.96 to 10 times higher amongst elderly nursing home residents than community-dwelling elderly people (Marrie 2002;Ronald 2008;Ticinesi 2016), with a 2.29 times higher rate of 30-day mortality (Liapikou 2014). This may be attributable to the particular characteristics of residents of nursing homes and long-term care facilities, as they tend to be older, to have greater functional impairment and to have increased comorbidities, polypharmacy and dependence upon caregivers (Dudas 2000;Martínez-Moragón 2004).…”

Section: Authors' Conclusionmentioning

confidence: 99%

“…Comorbidities considered as risk factors for NHAP include the following (Klapdor 2012;Ticinesi 2016):…”

Section: Authors' Conclusionmentioning

confidence: 99%

Oral care measures for preventing nursing home-acquired pneumonia

Zhang

et al. 2016

Cochrane Database of Systematic Reviews

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“…1,2 Surrogate markers of multiple comorbidities (multi-morbidity) are also risk factors for pneumonia and include poor performance status, poor oral hygiene, high number of invasive indwelling medical devices, and polypharmacy. 3 Box 1 outlines the major risk factors for hospital admission. A tool that included factors such as age, smoking status, and pulmonary function was validated in a study and shown to predict the long-term risk of Box Abbreviations: COPD, chronic obstructive lung disease; CURB-65, confusion, urea, respiration, and blood pressure; PSI, pneumonia severity score.…”

mentioning

confidence: 99%