Geriatric Assessment and Prognostic Factors of Mortality in Very Elderly Patients With Community-Acquired Pneumonia

Calle, Alicia; Márquez, Miguel Ángel; Arellano, Marta; Pérez, Laura Mónica; Pi-Figueras, Maria; Miralles, Ramón

doi:10.1016/j.arbr.2014.01.012

Cited by 23 publications

(28 citation statements)

References 22 publications

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“…Previous reports on dementia and in-hospital mortality in elderly people with pneumonia showed mixed results. Several studied showed patients with dementia were at higher risk of mortality after pneumonia [9,26], whereas a previous prospective study showed impaired cognitive function was not significantly associated with in-hospital death in patients aged ≥75 years [12]. In our study, patients with dementia hospitalized with pneumonia were not necessarily at a higher risk of death.…”

Section: Discussioncontrasting

confidence: 36%

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Association between dementia and discharge status in patients hospitalized with pneumonia

Yasunaga

Sasabuchi

et al. 2017

BMC Pulm Med

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Background: Pneumonia is the most common cause of death in patients with dementia, but the outcomes of patients with dementia hospitalized with pneumonia are poorly understood. We sought to illuminate the association between dementia and in-hospital mortality and discharge status in patients hospitalized with pneumonia. Methods: We used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify retrospectively patients aged ≥60 years admitted to hospital with pneumonia during the study period of May 1, 2010 to March 31, 2014. We recorded their sex, age, body mass index, severity of pneumonia and comorbidities (including dementia). The outcomes were in-hospital mortality and discharge home. Multivariable Cox regression analysis was performed to analyze factors influencing discharge home. Results: We identified 470,829 patients hospitalized with pneumonia; 45,031 were recorded as having dementia (9.6%). In-hospital mortality was 13.1% and 13.4% in patients with and without dementia, respectively (P = 0.63). The proportions of patients discharged home were 52.9% and 71.3% in patients with and without dementia, respectively (P < 0.001). The adjusted hazard ratio for discharge home for patients with dementia was 0.68 (95% confidence interval, 0.67-0.69; P < 0.001). Conclusions: In-hospital mortality from pneumonia did not differ significantly between patients with and without dementia; however, those with dementia were less likely to be discharged home.

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Section: Discussioncontrasting

confidence: 36%

“…Pneumonia is also reportedly associated with poor long-term prognosis in patients with dementia [8,9]. Several studies have assessed the association between independent comorbidities with in-hospital mortality [10][11][12] in patients with pneumonia; however, the influence of dementia is not completely understood.…”

Section: Introductionmentioning

confidence: 99%

Association between dementia and discharge status in patients hospitalized with pneumonia

Yasunaga

Sasabuchi

et al. 2017

BMC Pulm Med

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“…Three studies defined their own categories to describe level of arousal. Calle et al [34] described, but did not define, 'altered level of consciousness' , however the paper made clear that these were patients with reduced level of arousal, rather than agitation. Eight studies did not present the proportion of patients with reduced level of arousal; in the remaining 13 studies the prevalence ranged from 3.1%-76.9% (median 13.5%).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The majority of studies did not present sufficient information to allow us to comment on the presence of delirium, but it is established that acuteonset reduced level of arousal, in non-comatose patients, is a highly specific indicator of delirium [4,5,8,13]. Only two [4,34] of the included studies looked for delirium amongst their patients. Many studies of delirium specifically exclude patients with reduced level of arousal [19].…”

Section: Interpretation and Implications For Clinical Practice And Fumentioning

confidence: 99%

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57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

2018

Age and Ageing

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Background: Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods: We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results: From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 -83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions: Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium.

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A Composite of Functional Status and Pneumonia Severity Index Improves the Prediction of Pneumonia Mortality in Older Patients

Sanz

Morales-Suárez-Varela²,

Fernández

et al. 2018

J GEN INTERN MED

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Geriatric Assessment and Prognostic Factors of Mortality in Very Elderly Patients With Community-Acquired Pneumonia

Cited by 23 publications

References 22 publications

Association between dementia and discharge status in patients hospitalized with pneumonia

Association between dementia and discharge status in patients hospitalized with pneumonia

57reduced Level of Arousal and Increased Mortality in Adult Acute Medical Admissions: A Systematic Review and Meta-Analysis

A Composite of Functional Status and Pneumonia Severity Index Improves the Prediction of Pneumonia Mortality in Older Patients

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