Pneumonie-Schwere-Index (PSI), CURB-65 und Mortalität bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie

Heppner, Hans Jürgen; Sehlhoff, B.; Niklaus, David; Pientka, Ludger; Thiem, Ulrich

doi:10.1007/s00391-011-0184-3

Cited by 15 publications

(13 citation statements)

References 40 publications

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“…Although this is unsurprising, it is notable that these patients are more than twice as likely to die in the inpatient setting, even after accounting for age, comorbidities, and disease severity. These findings are similar to three previously published studies comparing aspiration and nonaspiration pneumonia at single institutions, albeit using different aspiration pneumonia definitions . This study is the first large, multicenter, multinational study to demonstrate these findings.…”

Section: Discussionsupporting

confidence: 91%

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Characteristics associated with clinician diagnosis of aspiration pneumonia: A descriptive study of afflicted patients and their outcomes

Lanspa

Peyrani

Wiemken

et al. 2014

Journal of Hospital Medicine

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Background Aspiration pneumonia is a common disease, although less well characterized than other pneumonia syndromes. Objective We analyzed patient-level covariates associated with clinician-defined aspiration pneumonia. Methods We used the Community-Acquired Pneumonia Organization (CAPO) database, a multicenter, international population of patients with community-acquired pneumonia, using data from 2001 to 2012. Aspiration pneumonia was determined by the treating clinician. We analyzed covariates associated with clinician-defined diagnosis of aspiration pneumonia using logistic regression. We compared aspiration pneumonia patients to propensity-matched cases with non-aspiration pneumonia. Results We studied 5185 patients. 451 of these patients had aspiration pneumonia. Patients with aspiration pneumonia were older, had greater disease severity, and more comorbidities than patients with non-aspiration pneumonia. They were more likely cared for in the intensive care unit (19% vs. 13%, p=0.002), had longer unadjusted hospital length of stay (9 vs. 7 days, p<0.001), and took longer to achieve clinical stability (unadjusted 8 vs. 4 days, p<0.001). Confusion, nursing home residence, and cerebrovascular disease were most associated with clinician diagnosis of aspiration pneumonia (OR 4.4, 2.9, 2.3 respectively). Unadjusted inpatient mortality was higher (23% vs. 9%, p < 0.001). Aspiration pneumonia conferred a 2.3 odds ratio for inpatient mortality, after adjusting for age, disease severity, and comorbidities. Conclusions Among pneumonia patients, confusion, nursing home residence, and cerebrovascular disease are associated with a clinician diagnosis of aspiration, Aspiration pneumonia is associated with greater mortality among patients with community-acquired pneumonia, which is not explained by older age, measured indices of severity, or comorbidities.

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Section: Discussionsupporting

confidence: 91%

“…Previous studies have demonstrated that patients with aspiration pneumonia are older and have greater disease severity and more comorbidities . These single‐center studies also demonstrated greater mortality, more frequent admission to an intensive care unit (ICU), and longer hospital lengths of stay in patients with aspiration pneumonia.…”

mentioning

confidence: 99%

Characteristics associated with clinician diagnosis of aspiration pneumonia: A descriptive study of afflicted patients and their outcomes

Lanspa

Peyrani

Wiemken

et al. 2014

Journal of Hospital Medicine

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“…22 Even if these scores are useful in the adult population, demonstrating its effectiveness and safety in increasing the proportion of low-risk patients who can receive treatment in the outpatient setting, 21 in geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value. 23 Moreover, it has been demonstrated that they are rarely used by physicians in clinical practice, mainly because of a large number of variables needed to calculate each score. 24 Therefore, an accurate assessment of the appropriate site of care for elderly patients cannot rely only on the assessment scores and other factors should be considered.…”

Section: Comorbidity and Pneumonia In The Elderlymentioning

confidence: 99%

Pneumonia and hospitalizations in the elderly

Cacciatore¹,

Gaudiosi²,

Mazzella

et al. 2017

Geriatr Care

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Pneumonia in the elderly is a common and severe problem. In this review we analyze the state of the art for pneumonia in the elderly. Several aspects are discussed: i) how common is the disease; signs and symptoms in the elderly; ii) the elderly must always be hospitalized and which is the best place -Intensive Care Unit or medical ward?; iii) the role of comorbidities; iv) etiology and pathogenesis; medical treatment -when and how to start; v) antibiotic resistance; vi) antibiotics in hospital acquired and ventilator related pneumonia; vii) assisted non-invasive ventilation; viii) the treatment in the terminally ill elderly patient.

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“…Aging itself can alter the swallowing mechanism and host defenses, but comorbidities, cognitive impairment and disability are the main reasons why aspiration pneumonia is more common in elderly patients [50]. Moreover, aspiration is a risk factor for severe pneumonia and carries a high mortality rate [51,52]. …”

Section: What Antibiotic Treatment Should Be Chosen In An Elderly mentioning

confidence: 99%

The management of community-acquired pneumonia in the elderly

Faverio¹,

Aliberti²,

Bellelli³

et al. 2014

European Journal of Internal Medicine

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Pneumonia is one of the main causes of morbidity and mortality in the elderly. The elderly population has exponentially increased in the last decades and the current epidemiological trends indicate that it is expected to further increase. Therefore, recognizing the special needs of older people is of paramount importance. In this review we address the main differences between elderly and adult patients with pneumonia. We focus on several aspects, including the atypical clinical presentation of pneumonia in the elderly, the methods to assess severity of illness, the appropriate setting of care, and the management of comorbidities. We also discuss how to approach the common complications of severe pneumonia, including acute respiratory failure and severe sepsis. Moreover, we debate whether or not elderly patients are at higher risk of infection due to multi-drug resistant pathogens and which risk factors should be considered when choosing the antibiotic therapy. We highlight the differences in the definition of clinical stability and treatment failure between adults and elderly patients. Finally, we review the main outcomes, preventive and supportive measures to be considered in elderly patients with pneumonia.

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Pneumonie-Schwere-Index (PSI), CURB-65 und Mortalität bei hospitalisierten geriatrischen Patienten mit Aspirationspneumonie

Abstract: In geriatric patients hospitalized with aspiration pneumonia, CURB-65 and PSI have no prognostic value.

Cited by 15 publications

References 40 publications

Characteristics associated with clinician diagnosis of aspiration pneumonia: A descriptive study of afflicted patients and their outcomes

Characteristics associated with clinician diagnosis of aspiration pneumonia: A descriptive study of afflicted patients and their outcomes

Pneumonia and hospitalizations in the elderly

The management of community-acquired pneumonia in the elderly

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