Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia

Abstract

Background Older patients hospitalized with community-acquired pneumonia (CAP) are at high risk for short-term mortality. Activity of daily living (ADL) is associated with clinical outcomes in older patients. We aimed to investigate the prognostic value of ADL upon admission on the in-hospital mortality in older patients with CAP. Methods We conducted a retrospective cohort study involving patients aged ≥65 years admitted to Beijing Chao-Yang hospital due to CAP between June 2012 and June 2020. ADL evaluation upon admission was performed by Barthel Index (BI). Data from all patients were extracted from the electronic medical records. Results Four thousand eight hundred eighty patients were included, 131 patients (2.7%) died during their hospitalization. Median BI in the Deceased group was 45 (20–65), Deceased group had lower BI scores than Survivors group (p < 0.001). Low BI (< 60) was more frequent in patients who died in the hospital than in patients discharged alive (69.5% vs. 13%, p < 0.001). In-hospital mortality was higher among patients with worse ADL upon admission (BI< 60) compared to those BI≥60 (12.6% vs. 0.9%). The worse ADL upon admission (BI< 60) was associated with an increase in the risk of death during CAP hospitalization, worse ADL upon admission (BI< 60) showed an odds ratio (OR) for in-hospital mortality of 7.53 (95%CI: 2.77–20.48; P < 0.01). This association remained significant after adjustment for age, comorbid conditions, respiratory failure, pathogens and laboratory findings (OR, 3.74; 95%CI, 2.37–5.91; P < 0.01). Receiver operating characteristic (ROC) curve revealed that BI upon admission is a predictor related to in-hospital mortality in elderly patients, the area under the ROC curve of BI in predicting in-hospital mortality was 0.81 (with 95% confidence interval: 0.78–0.85). The predictive value of ADL upon admission was better than age in our study population. Conclusion Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia.

Comparison of Different Scoring Systems for Prediction of Mortality and ICU Admission in Elderly CAP Population

“…Secondly, we did not take into account functional decline, dysphagia ability or frailty, which could influence the prognosis of patients with CAP. [50][51][52] Moreover, it is well known that mortality in patients with aspiration is significantly higher in nonaspiration pneumonia, 53 while in our study CAP was not differentiated from aspiration pneumonia as the population was small which is corroborated in past studies estimating 5%-15% cases of community-acquired pneumonia. 54,55 Such studies with large population need to be designed in the future.…”

Combination of the Barthel Index at Discharge with GRACE Leads to Improved One-Year Mortality Prediction in Older Patients with Acute Myocardial Infarction

“…[28][29][30] For patients with specific diseases, such as hip fractures, dementia, pneumonia, heart failure and nonvalvular atrial fibrillation, a low BI score usually indicates poor outcomes. [31][32][33][34][35] These findings constitute compelling evidence that another dimension, physical performance, should be taken into consideration in the management of diseases. Older adults make up a significant portion of ACS patients, but it has been recognized that age alone may not be sufficient for risk stratification.…”

Prognostic Factors for Cardiovascular Events in Elderly Patients with Community Acquired Pneumonia: Results from the CAP-China Network

“…A retrospective cohort study from China by Kang and coworkers assessing 4880 CAP patients aged ≥ 65 years showed that BUN was a prognostic factor for in-hospital mortality. 35 Data from a multicenter prospective study on the Implications of acute Cardiovascular Events in patients hospitalized for Community-Acquired Pneumonia (ICECAP), enrolling patients consecutively hospitalized from 2016 to 2018, indicated the occurrence of any CVE during hospitalization independently and significantly increased the risk of 30-day mortality (HR 1.69; 95% CI, 1.14–2.51, p = 0.009); while newly diagnosed heart failure, new onset atrial fibrillation or flutter, acute coronary syndrome, separately, were not associated with increased risk of 30-day mortality. 12 The current study is the first to our knowledge to illustrate new CVDs, new heart failure, and new arrhythmia were independently and significantly increased the risk of 30-day mortality for elderly patients with CAP.…”