The Impact of Age and Comorbidities on the Mortality of Patients of Different Age Groups Admitted with Community-acquired Pneumonia

Luna, Carlos M.; Palma, Ileana; Niederman, Michael S.; Membriani, Evangelina; Giovini, Vanina; Wiemken, Timothy; Peyrani, Paula; Ramirez, Julio A.

doi:10.1513/annalsats.201512-848oc

Cited by 84 publications

(95 citation statements)

References 20 publications

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“…In a secondary analysis of 6205 patients with community-acquired pneumonia (CAP), 508 (8.2%) died within 30 days. In the overall population, mortality increased with age; however, in the subgroup of patients with one co-morbidity or less, mortality was not different between patients younger than 65 years old and those 65-79 years old, but it was higher for those aged 80 years and older, suggesting that age greater than 80 years, instead of age greater than 65 years, should be considered as the appropriate age-related risk factor for poor outcome in CAP [36].…”

Section: Factors Associated With Mortalitymentioning

confidence: 83%

“…Vice versa, the outcome of non-ICU care must also be known if we want to make the proper comparison. As discussed, there is ample evidence that age is associated with decisions to refuse ICU admission [36][37][38][39]. Yet, there currently is no robust or validated clinical prediction tool that is able to reliably indicate the VOP who will substantially benefit from ICU care.…”

Section: Costs-benefits For Elderly Patientsmentioning

confidence: 99%

See 1 more Smart Citation

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

209

196

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The "very old intensive care patients" (abbreviated to VOPs; greater than 80 years old) are probably the fastest expanding subgroup of all intensive care unit (ICU) patients. Up until recently most ICU physicians have been reluctant to admit these VOPs. The general consensus was that there was little survival to gain and the incremental life expectancy of ICU admission was considered too small. Several publications have questioned this belief, but others have confirmed the poor long-term mortality rates in VOPs. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making and improved prediction models are also needed for this particular patient group. Here, an expert panel proposes a research agenda for VOPs for the coming years.

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Section: Factors Associated With Mortalitymentioning

confidence: 83%

Section: Costs-benefits For Elderly Patientsmentioning

confidence: 99%

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

209

196

View full text Add to dashboard Cite

show abstract

“…These factors include, among others, illness severity or antimicrobial treatments 32. Additionally, we also cannot identify whether gradual changes were made in referral practice during the study period.…”

Section: Discussionmentioning

confidence: 97%

Hospitalisation with community-acquired pneumonia among patients with type 2 diabetes: an observational population-based study in Spain from 2004 to 2013

et al. 2017

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ObjectivesTo describe trends in the incidence and outcomes of community-acquired pneumonia (CAP) hospitalisations among patients with or without diabetes in Spain (2004–2013).DesignRetrospective, observational study using the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos (CMBD)).SettingSpain.ParticipantsWe used national hospital discharge data to select all hospital admissions for CAP.Main outcome measuresIncidence was calculated overall and stratified by diabetes status: type 2 diabetes mellitus (T2DM) and no diabetes.ResultsWe identified 901 136 admissions for CAP (24.8% with T2DM). Incidence rates of CAP increased significantly in patients with T2DM over time. The incidence was higher among people with T2DM for all time periods. Patients with T2DM were older and had higher comorbidity index than non-diabetics. Streptococcus pneumoniae decreased over time for both groups. Time trend analyses showed significant decreases in mortality during admission for CAP for patients with and without T2DM. Factors associated with higher mortality in both groups included: older age, higher comorbidity, mechanical ventilation, red cell transfusion, readmission and Staphylococcus aureus detection. Diabetes was associated with a lower in-hospital mortality (OR 0.92, 95% CI 0.91 to 0.94) after a CAP hospitalisation.ConclusionsCAP incidence rates were higher and increased over time at a higher rate among patients with T2DM. Mortality decreased over time in all groups. The presence of diabetes is not a risk factor for death during admission for CAP.

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“…The presence of comorbidities is the most important factor linked to poorer outcomes. 2 Chronic obstructive pulmonary disease (COPD) is a condition characterized by persistent airflow limitation and inflammation. It is generally progressive and associated with chronically increased inflammatory response in the airways and lungs as a consequence of exposure to noxious particles or gases.…”

Section: Introductionmentioning

confidence: 99%

“…In this case, COPD was not an independent factor associated with mortality. 2 A case-control study from Switzerland observed lower in-hospital mortality and a lower rate of complications when COPD was present. 7 Nonetheless, Torres et al reported that asthma, smoking, chronic cardiovascular disease, diabetes and COPD increase the risk for pneumococcal disease (CAP and invasive pneumococcal disease), and have a detrimental effect on outcomes.…”

Section: Introductionmentioning

confidence: 99%

The presence of COPD does not influence clinical outcomes in hospitalized patients with community-acquired pneumonia.

Silva¹,

Gearhart²,

Maciel³

et al. 2017

JRI

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Introduction: Community acquired pneumonia (CAP) is a leading cause of death worldwide. Chronic obstructive pulmonary disease (COPD) is a well-established risk factor for development of CAP. What is not as clear is the impact of COPD on the outcomes of patients with CAP. In this study, we compared the outcomes of CAP in COPD and non-COPD patients. Methods: This was a retrospective cohort study. We conducted an analysis of the CommunityAcquired Pneumonia Organization (CAPO) international cohort study database, which includes patients with CAP admitted to several hospitals throughout the world. Patients were categorized into two groups based on the status of COPD: COPD positive or negative. Outcomes were time to clinical stability, length of hospital stay, and in-hospital mortality. Regression models were used to assess the independent effect of COPD on the outcomes. Results: This study included 7,325 patients. Of these, 1,869 (25.5%) had COPD. Patients with COPD had higher severity of illness (pneumonia severity index class V: 15% vs 9%; P <0.001). Accelerated failure time models with adjustment for co-variates showed no significant difference in the probability of clinical stability (P = 0.451) and of discharge (P = 0.232) in COPD vs. non-COPD patients. There was no difference in the crude in-hospital mortality between COPD and non-COPD patients (9% vs 9%; P = 0.37). Conclusion: Our study results show that COPD should not be considered a risk factor for poor outcomes in hospitalized patients with CAP.

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The Impact of Age and Comorbidities on the Mortality of Patients of Different Age Groups Admitted with Community-acquired Pneumonia

Cited by 84 publications

References 20 publications

The status of intensive care medicine research and a future agenda for very old patients in the ICU

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Hospitalisation with community-acquired pneumonia among patients with type 2 diabetes: an observational population-based study in Spain from 2004 to 2013

The presence of COPD does not influence clinical outcomes in hospitalized patients with community-acquired pneumonia.

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