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Short-term mortality among older persons hospitalized for pneumonia: influence of baseline patient characteristics beyond severity of illness.

Abstract：

BACKGROUND:Although severity of illness indices such as pneumonia severity index (PSI) are good predictors of short-term mortality for community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), other patient factors may have added prognostic value. OBJECTIVE:To identify patient factors beyond the PSI which explain 30-day mortality among older persons hospitalized with CAP and HCAP. DESIGN:Retrospective cohort study. SETTING:Three acute care hospitals in Singapore in 2007. PATIENTS:Hospitalized adults aged 65 years or older who have primary International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes 480 to 486 with clinical and radiological features of pneumonia. INTERVENTIONS:None. MEASUREMENTS:Thirty-day mortality, PSI class, demographic and clinical features, comorbid conditions, functional status, selected laboratory tests, and chest radiographic findings. RESULTS:Among 1607 patients included, 890 (55.4%) had CAP and 717 (44.6%) had HCAP. After adjustment for PSI class in logistic regression analyses, pre-morbid ambulation impairment (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.98 to 3.45), hospitalization in the prior 30 days (OR 1.93, 95% CI 1.38 to 2.71), and absence of cough and purulent sputum (OR 1.47, 95% CI 1.14 to 1.90) were all significantly associated with 30-day mortality. These associations remained constant when CAP and HCAP were analyzed separately. CONCLUSIONS:Recent hospitalization, pre-morbid ambulation impairment, and atypical presentation were independently associated with higher 30-day mortality among older persons hospitalized for pneumonia, after adjusting for severity of illness. These factors could be considered in addition to PSI when performing risk stratification and adjustment in this setting.

journal_name

J Hosp Med

journal_title

Journal of hospital medicine

authors

Ding YY,Abisheganaden J,Chong WF,Heng BH,Lim TK

doi

10.1002/jhm.985

subject

Has Abstract

pub_date

2012-03-01 00:00:00

pages

211-7

issue

eissn

1553-5592

issn

1553-5606

journal_volume

pub_type

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Short-term mortality among older persons hospitalized for pneumonia: influence of baseline patient characteristics beyond severity of illness.