Indicators of Recurrent Hospitalization for Pneumonia in the Elderly

Solh, Ali A. El; Brewer, Thomas G.; Okada, Mifue; Bashir, Omar; Gough, Michael S.

doi:10.1111/j.1532-5415.2004.52556.x

Cited by 43 publications

(61 citation statements)

References 32 publications

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“…Previous studies on the impact of initial treatment on outcome have focused on critically ill patients [14,15,33] and patients with bacteraemia [34]. In a recent study of elderly CAP patients, modification of treatment due to a combination of causes (inefficiency, detection of uncovered microorganisms or intolerance) had no influence on outcome [7], which may be due to the different reasons underlying the decision to change.…”

Section: Discussionmentioning

confidence: 99%

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Kothe

Bauer²,

Marre³

et al. 2008

European Respiratory Journal

168

103

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Community-acquired pneumonia remains a major cause of mortality in developed countries. There is much discrepancy in the literature regarding factors influencing the outcome in the elderly population.Data were derived from a multicentre prospective study initiated by the German Competence Network for Community-Acquired Pneumonia. Patients with community-acquired pneumonia (n52,647; 1,298 aged ,65 yrs and 1,349 aged o65 yrs) were evaluated, of whom 72.3% were hospitalised and 27.7% treated in the community. Clinical history, residence status, course of disease and antimicrobial treatment were prospectively documented. Microbiological investigations included cultures and PCR of respiratory samples and blood cultures. Factors related to mortality were included in multivariate analyses.The overall 30-day mortality was 6.3%. Elderly patients exhibited a significantly higher mortality rate that was independently associated with the following: age; residence status; confusion, urea, respiratory frequency and blood pressure (CURB) score; comorbid conditions; and failure of initial therapy. Increasing age remained predictive of death in the elderly. Nursing home residents showed a four-fold increased mortality rate and an increased rate of Gram-negative bacillary infections compared with patients dwelling in the community. The CURB score and cerebrovascular disease were confirmed as independent predictors of death in this subgroup.Age and residence status are independent risk factors for mortality after controlling for comorbid conditions and disease severity. Failure of initial therapy was the only modifiable prognostic factor.

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Section: Discussionmentioning

confidence: 99%

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Kothe

Bauer²,

Marre³

et al. 2008

European Respiratory Journal

168

103

View full text Add to dashboard Cite

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“…Recurrent pneumonia has generally been previously defined as a discrete episode of pneumonia separated by at least a 1-month asymptomatic interval, a radiographic clearing of the acute infiltrate, or both [7][8][9][10], though some studies have used a shorter asymptomatic interval of 14 days [11]. A recent study further subdivided episodes of recurrent pneumonia into ''early'' and ''late'' recurrence, which defined ''early'' recurrence as episodes of pneumonia between 30 and 90 days and ''late'' recurrence as episodes of pneumonia beyond 90 days in order to discern the difference between relapse, recrudescence, and true recurrence [10].…”

Section: Rates Of Recurrent Pneumoniamentioning

confidence: 99%

“…Although there is much written about the rates of incident pneumonia, the incidence and rates of recurrent episodes of pneumonia is much more difficult to track because of these different definitions and the lack of systematic, long-term follow-up of those who survive an episode of pneumonia. Studies from the mid-1900s determined the recurrence of pneumonia to be as high as 13-67 % [7][8][9][11][12][13] while more recent studies show a lower rate at 9-12 % over 3-5 years [9,10] with median time to recurrence ranging from 123 to 317 days [10,11].…”

Section: Rates Of Recurrent Pneumoniamentioning

confidence: 99%

Recurrent Pneumonia: A Review with Focus on Clinical Epidemiology and Modifiable Risk Factors in Elderly Patients

et al. 2014

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Community-acquired pneumonia (CAP) is one of the most common reasons for physician visits and hospitalizations in North America. Rates of CAP increase with age and CAP is associated with significant morbidity and mortality, especially in the elderly. Though there is much written about the epidemiology and risk factors of incident (first episode) pneumonia, much less is known about recurrent pneumonia. Rates of recurrent pneumonia within 3-5-years of an episode of CAP are 9-12% with a median time to recurrence of 123-317 days and mortality ranging from 4 to 10%. Age ≥65-years-old and impaired functional status are the only patient characteristics that are independently associated with increased risk of recurrence. In terms of modifiable risk factors, only the use of proton-pump inhibitors and systemic and inhaled corticosteroids have consistently been associated with increased risk of recurrent pneumonia, while angiotensin-converting enzyme (ACE) inhibitors may exert a protective effect. Many chronic medical conditions typically associated with increased incident pneumonia-such as chronic obstructive pulmonary disease (COPD), neurological disease (resulting in dysphagia or silent aspiration), and heart failure-were not associated with increased risk of recurrent pneumonia. However, those who are immune-suppressed (e.g., immunoglobulin deficiencies) may be at increased risk of recurrent pneumonia. In summary, among those who survive an episode of pneumonia, recurrence is not uncommon, particularly in the elderly. Following recovery from an episode of pneumonia, patients should be evaluated for risk factors that would predispose to a second episode including seeking evidence of immunosuppression in younger patients and medication optimization, particularly in the elderly.

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“…A recent systematic review 2 of 26 models uncovered: most models perform poorly, including the 3 CMS models (pneumonia, heart failure, and myocardial infarction); only one clinical model successfully met the goals set forth for clinical application and had what is considered acceptable discriminative ability when detecting readmission for heart failure 3 ; the successful addition of social or functional variables offer opportunities for improvement in model performance. 4,5 There are few readmission models centered on pneumonia 30 day readmissions, [6][7][8][9][10][11][12] and only a few reported on discriminative ability. 6,11,12 In this single-center, retrospective analysis our intention was to leverage variables shown to be significant in previously reported predictive models and supplement the CMS medical record model 6 with additional variables shown to be of benefit in other models, in an effort to produce a model to identify before discharge patients at high risk for readmission.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Pneumonia 30-Day Readmissions: A Single-Center Attempt to Increase Model Performance

Mather¹,

Fortunato²,

Ash³

et al. 2013

Respir Care

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BACKGROUND: Existing models developed to predict 30 days readmissions for pneumonia lack discriminative ability. We attempted to increase model performance with the addition of variables found to be of benefit in other studies. METHODS: From 133,368 admissions to a tertiary-care hospital from January 2009 to March 2012, the study cohort consisted of 956 index admissions for pneumonia, using the Centers for Medicare and Medicaid Services definition. We collected variables previously reported to be associated with 30-day all-cause readmission, including vital signs, comorbidities, laboratory values, demographics, socioeconomic indicators, and indicators of hospital utilization. Separate logistic regression models were developed to identify the predictors of all-cause hospital readmission 30 days after discharge from the index pneumonia admission for pneumonia-related readmissions, and for pneumonia-unrelated readmissions. RESULTS: Of the 965 index admissions for pneumonia, 148 (15.5%) subjects were readmitted within 30 days. The variables in the multivariate-model that were significantly associated with 30-day all-cause readmission were male sex (odds ratio 1.59, 95% CI 1.03-2.45), 3 or more previous admissions (odds ratio 1.84, 95% CI 1.22-2.78), chronic lung disease (odds ratio 1.63, 95% CI 1.07-2.48), cancer (odds ratio 2.18, 95% CI 1.24 -3.84), median income < $43,000 (odds ratio 1.82, 95% CI 1.18 -2.81), history of anxiety or depression (odds ratio 1.62, 95% CI 1.04 -2.52), and hematocrit < 30% (odds ratio 1.86, 95% CI 1.07-3.22). The model performance, as measured by the C statistic, was 0.71 (0.66 -0.75), with minimal optimism according to bootstrap re-sampling (optimism corrected C statistic 0.67). CONCLUSIONS: The addition of socioeconomic status and healthcare utilization variables significantly improved model performance, compared to the model using only the Centers for Medicare and Medicaid Services variables.

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Indicators of Recurrent Hospitalization for Pneumonia in the Elderly

Cited by 43 publications

References 32 publications

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Recurrent Pneumonia: A Review with Focus on Clinical Epidemiology and Modifiable Risk Factors in Elderly Patients

Prediction of Pneumonia 30-Day Readmissions: A Single-Center Attempt to Increase Model Performance

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