Pneumonia severity, comorbidity and 1-year mortality in predominantly older adults with community-acquired pneumonia: a cohort study

Abstract

BackgroundIn patients with community-acquired pneumonia (CAP), short-term mortality is largely dependent on pneumonia severity, whereas long-term mortality is considered to depend on comorbidity. However, evidence indicates that severity scores used to assist management decisions at disease onset may also be associated with long-term mortality. Therefore, the objective of the study was to investigate the performance of the pneumonia severity scores CURB-65 and CRB-65 compared to the Charlson Comorbidity Index (CCI) for predicting 1-year mortality in adults discharged from hospital after inpatient treatment for CAP.MethodsFrom a single centre, all cases of patients with CAP treated consecutively as inpatients between 2005 and 2009 and surviving at least 30 days after admission were analysed. The patients’ vital status was obtained from the relevant local register office. CURB-65, CRB-65 and CCI were compared using receiver operating characteristics (ROC) analysis.ResultsOf 498 cases analysed, 106 (21.3%) patients died within 1 year. In univariate analysis, age ≥65 years, nursing home residency, hemiplegia, dementia and congestive heart failure were significantly associated with mortality. CURB-65, CRB-65 and CCI were also all associated with mortality at 1 year. ROC analysis yielded a weak, yet comparable test performance for CURB-65 (AUC and corresponding 95% confidence interval [CI] for risk categories: 0.652 [0.598-0.706]) and CCI (AUC [CI]: 0.631 [0.575-0.688]; for CRB-65 0.621 [0.565-0.677] and 0.590 [0.533-0.646]).ConclusionsNeither CURB-65 or CRB-65 nor CCI allow excellent discrimination in terms of predicting longer term mortality. However, CURB-65 is significantly associated with long-term mortality and performed equally to the CCI in this respect. This fact may help to identify CAP survivors at higher risk after discharge from hospital.

Significance of adipose tissue mass for the clinical course of pneumonia associated with decompensated CHF

“…ОРИГИНАЛЬНЫЕ СТАТЬИ § П невмония в последнее время становится одной из важнейших причин внутригоспитальной летальности (в острый период заболевания) у больных с декомпенсацией ХСН. Пневмония, как минимум, в течение года отрицательно влияет на прогноз пациентовI: в некоторых популяциях смертность в течение года после перенесенной пневмонии может достигать 40 % [1][2][3][4][5][6][7][8][9][10][11][12][13]. По данным Павловского регистра [14], который является частью регистра «ОРАКУЛ-РФ» [15], количество пневмоний у пациентов в момент декомпенсации ХСН превышает 38 %, что значительно выше, чем в мировых регистрах [16][17][18][19].…”

Five‐year mortality in patients treated for severe community‐acquired pneumonia – a retrospective study

“…To actually compare COPD patients to patients without COPD, it is necessary to divide the non‐COPD group into two subgroups, one group with comorbidity, and one group presumably healthy (no comorbidity; Charlson score = 0) before arrival at the ICU, as comorbidity is relevant when it comes to the long‐term mortality …”

Can animal models really teach us anything about pneumonia? Pro

“…In contrast, animal studies can identify weaker or less common predispositions to pneumonia, and also define the underlying molecular mechanisms involved. For example, the exponential increased risk of Streptococcus pneumoniae pneumonia in the elderly [35,36] has multifactorial causes which are hard to define using epidemiology alone. Animal model research has linked age-related changes in DNA integrity and the gut microbiome to increased background inflammation that impairs immunity to S. pneumoniae by increasing expression of epithelial ligands for bacterial adhesion, impairing monocyte function, and reducing TLR2 expression [37][38][39].…”