Prognostic factors of 90‐day mortality in older people with healthcare‐associated pneumonia

Abstract

Aim: The Quick Sequential Organ Failure Assessment, and confusion, urea, respiratory rate, blood pressure and age (CURB-65) scores have been used as prognostic factors of mortality related to healthcare-associated pneumonia. However, aspiration pneumonia remains unclear. Methods: A cross-sectional, prospective cohort study was carried out with 130 inpatients aged ≥75 years at a Geriatric ward of Kyorin University Hospital, Japan. We investigated the utility of aspiration pneumonia-related factors, latency of swallowing reflex and cough reflex sensitivity, serum albumin levels, the neutrophil-to-lymphocyte ratio, and conventional scores of pneumonia severity, for predicting 30-and 90-day healthcare-associated pneumonia mortality. Patient demographics, cognition, physical activity (Barthel Index), eating ability (Food Intake Level Scale), dementia stage (Functional Assessment Staging Tool), performance status (Zubrod score), current medications and comorbidities were collected. Pneumonia severity was evaluated using the Quick Sequential Organ Failure Assessment, CURB-65 and Systemic Inflammatory Response Syndrome criteria scores. Results: Age, Barthel Index, Zubrod, Functional Assessment Staging Tool and Food Intake Level Scale scores were significantly associated with mortality, whereas the conventional scores were not. The Kaplan-Meier method with the log-rank test using Cox proportional hazards analysis showed that serum albumin levels <2.75 and the comorbidity of atrial fibrillation were associated with a lower survival rate in deceased versus surviving individuals at 90 days. In addition, a deteriorated latency of swallowing reflex and a blunted cough reflex sensitivity were associated with 90-day mortality. Conclusions: Hypoalbuminemia, atrial fibrillation, deteriorated latency of swallowing reflex and blunted cough reflex sensitivity values were better predictors of 90-day mortality than traditional scores in older individuals with healthcare-associated pneumonia.

Validation of the applicability of the mealtime observation checklist in predicting the risk of aspiration pneumonia in older adults receiving oral intake support: A retrospective cohort study of four long‐term care facilities

“…In addition, unstable posture can be distracting and can interfere with chewing and bolus transfer. Next, if the participant sleeps while eating, a decreased level of consciousness may delay the swallowing reflex, which has previously been reported to be associated with aspiration and pneumonia 21,22 . Likewise, when the participant has difficulty concentrating on eating, inappropriate timing of swallow is considered to occur.…”

“…Next, if the participant sleeps while eating, a decreased level of consciousness may delay the swallowing reflex, which has previously been reported to be associated with aspiration and pneumonia. 21,22 Likewise, when the participant has difficulty concentrating on eating, inappropriate timing of swallow is considered to occur. It has also been suggested that frail older adults are less able to withstand the physical strain of eating and are more likely to experience fatigue and difficulty in stabilizing their posture while eating.…”

Construction and evaluation of a nomogram prediction model for aspiration pneumonia in patients with acute ischemic stroke

“…(4) Atrial fibrillation : Studies have indicated that the detachment of mural thrombus resulting from atrial fibrillation was also a significant cause of AIS. Furthermore, a separate study involving 130 hospitalized patients aged over 75 with AP demonstrated that atrial fibrillation significantly reduced the 90-day survival rate of patients (P = 0.039) [ 33 ]. (5) There were also studies reporting that patients with poor organ function (such as Cardiac, Renal, and Hepatic insufficiency ) and overall nutritional status ( Prealbumin ) caused by long-term disease status might also have an increased susceptibility to AP [ 34 ].…”

Development and validation of prediction models for the discharge destination of elderly patients with aspiration pneumonia

“…With respect to the predictors, no variable selection was performed since the deletion of variables, even non-significant ones, could impair predictive accuracy [20]. Following a review of the existing studies, we established the final prediction models with 19 predictors associated with outcomes that had been used in previous studies [16,[21][22][23][24][25][26][27][28][29]. The following predictor data were collected at admission: patient age (65-69, 70-74, 75-79, 80-84, 85-89, 90-94, and �95 years), sex, BMI (<17.0, 17.0-18.4, 18.5-24.9, 25.0-29.90, and �30.0) [30], need for assistance with at least one of the ten activities of daily living (ADL) in the Barthel index (feeding, bathing, grooming, dressing, bowel control, bladder control, toilet use, transfers from bed to chair, mobility on level surfaces, and stairs) [31], malnutrition, consciousness level (using the Japan coma scale: 0: alert; 1-3: delirious; 10-30: somnolent; and 100-300: coma), emergency hospitalization, previous unplanned hospitalization for aspiration pneumonia within the last 90 days at the same hospital, and comorbidities.…”