The impact of multimorbidity on short-term events in patients with community-acquired pneumonia: prospective cohort study

Abstract

The impact of multimorbidity on patients with community-acquired pneumonia has not been well characterised. Thus, our aim was to explore the relationship between multimorbidity and adverse events within 90 days of discharge. Data were prospectively collected for a population-based cohort of all adults discharged from any of the seven emergency departments (ED) or six hospitals in Edmonton (Alberta, Canada) with community-acquired pneumonia. Multivariable Cox regression models were used to examine the independent association between multimorbidity (defined as two or more chronic conditions) and subsequent 90-day mortality, hospitalisation, or ED visits after treatment of pneumonia. The cohort included 5565 patients, mean age was 57 years (SD 20), 54% were male, and 59% were treated as outpatients; 1602 (29%) patients had multimorbidity. Within 90 days, 255 (5%) patients died, 1205 (22%) were hospitalised, 1280 (23%) died or were hospitalised, and 2049 (37%) were admitted to the ED. The presence of multimorbidity was independently associated with an increased risk of death or hospitalisation within 90 days (37% vs. 17% for those without multimorbidity, adjusted hazard ratio: 1.43, 95% confidence interval: 1.26 to 1.62) as well as ED visits (45% vs. 34%, adjusted hazard ratio: 1.40, 95% confidence interval: 1.26 to 1.56). Multimorbidity was present in one-third of all patients with pneumonia in our study, and it was independently associated with death, hospitalisation, or return to ED within 90 days of discharge. Our findings suggest that multimorbidity is strongly related to prognosis and should be considered when making site-of-care decisions in the ED or deciding upon readiness for discharge.

Concurrent Infection with Hepatitis C Virus andStreptococcus pneumoniae

“…Third, we adjusted for the following concurrent conditions: solid organ cancer, HIV, diabetes, coronary heart disease, and chronic obstructive pulmonary disease. In addition, we included a marker for the presence of > 2 other chronic conditions as a measure of additional illnesses as reported ( 12 , 13 ). Fourth, we included functional status in our model (independently walking versus not walking before hospital admission) because this factor has better prognostic value than age and disease severity and acts as a proxy for frailty ( 14 ).…”

Healthcare reconsultation in working-age adults following hospitalisation for community-acquired pneumonia

“…9 Younger working-age adults without significant comorbidity have lower rates of adverse outcomes and thus, healthcare reconsultation rates might be expected to be lower and potentially modifiable. 10,11 However, there are currently no data on either overall rates of healthcare utilisation or reasons for these reconsultations in these younger individuals. This study was designed to quantify overall healthcare reconsultation rates following hospital discharge for an index episode of CAP, and to describe reasons underpinning these healthcare reconsultations in working-age adults.…”

Manejo de la neumonía adquirida en la comunidad en el adulto mayor

“…Los principales factores de riesgo para un reingreso son el fallo terapéutico inicial, la inestabilidad clínica al egreso hospitalario, la edad avanzada, las comorbilidades y la alteración funcional. 19 En un estudio canadiense 32 se analizó el impacto a corto plazo de la multimorbilidad en pacientes con NAC y se determinó que se asocia independientemente con muerte, hospitalización y regreso al servicio de emergencias en los 90 días posteriores al egreso.…”