Contribution of clinical severity and geriatric risk factors in predicting short-term mortality of older hospitalized pneumonia patients: the Pneumonia in Italian Acute Care for Elderly units (PIACE) study.

Activities of Daily Living Aftercare Aged Aged, 80 and over Delirium Geriatric Assessment Humans Oxygen Patient Discharge Pneumonia Prognosis Risk Factors

Clinical severity Community-acquired pneumonia Comprehensive geriatric assessment Geriatric hospital wards

Journal

Aging clinical and experimental research

ISSN: 1720-8319

Titre abrégé: Aging Clin Exp Res

Pays: Germany

ID NLM: 101132995

Informations de publication

Date de publication:
Jun 2022

Historique:

received: 23 05 2021

accepted: 27 12 2021

pubmed: 24 2 2022

medline: 3 6 2022

entrez: 23 2 2022

Statut: ppublish

Résumé

Clinical severity of pneumonia in older persons increases the risk for short-term mortality. Comprehensive geriatric assessment (CGA) may provide further insight in prognostic stratification. To investigate whether CGA may improve prognostic stratification among older patients with pneumonia admitted to hospital. Our series consisted of 318 consecutive patients hospitalized for pneumonia in a multicenter observational study. Disease severity was assessed by Sequential Organ Failure Assessment (SOFA) and Pneumonia Severity Index (PSI). CGA included the occurrence of delirium, Basic Activities of Daily Living (BADL) disability, cognitive impairment at Short Portable Mental Status Questionnaire (SPMSQ) and overall comorbidity assessed by Cumulative Illness Rating Scale (CIRS). The outcomes were in-hospital and post-discharge 3 month mortality. Statistical analysis was carried out by Cox regression, area under receiver operating curve (AUC) and net reclassification index (NRI). Overall, 53 patients died during hospitalization and 52 after discharge. Delirium, SOFA score and admission BADL disability were significant predictors of in-hospital mortality. SOFA score, CIRS, previous long-term oxygen therapy and discharge BADL dependency significantly predicted post-discharge mortality. The accuracy of SOFA in predicting in-hospital and post-discharge mortality was fair (AUC = 0.685, 95% CI = 0.610-0.761 and AUC = 0.663, 95% CI = 0.593-0.734, respectively). BADL dependency and delirium improved predictive accuracy for in-hospital mortality (ΔAUC = 0.144, 95% CI = 0.062-0.227, p < 0.001), while pre-admission oxygen therapy, CIRS and BADL dependency improved predictivity for 3 month mortality (ΔAUC = 0.177, 95% CI = 0.102-0.252, p < 0.001). Among older pneumonia patients, prognostic stratification obtained by clinical severity indexes is significantly improved by CGA risk factors. CGA provides important information for prognostic stratification and clinical management of older pneumonia patients.

Sections du résumé

BACKGROUND BACKGROUND

Clinical severity of pneumonia in older persons increases the risk for short-term mortality. Comprehensive geriatric assessment (CGA) may provide further insight in prognostic stratification.

AIMS OBJECTIVE

To investigate whether CGA may improve prognostic stratification among older patients with pneumonia admitted to hospital.

METHODS METHODS

Our series consisted of 318 consecutive patients hospitalized for pneumonia in a multicenter observational study. Disease severity was assessed by Sequential Organ Failure Assessment (SOFA) and Pneumonia Severity Index (PSI). CGA included the occurrence of delirium, Basic Activities of Daily Living (BADL) disability, cognitive impairment at Short Portable Mental Status Questionnaire (SPMSQ) and overall comorbidity assessed by Cumulative Illness Rating Scale (CIRS). The outcomes were in-hospital and post-discharge 3 month mortality. Statistical analysis was carried out by Cox regression, area under receiver operating curve (AUC) and net reclassification index (NRI).

RESULTS RESULTS

Overall, 53 patients died during hospitalization and 52 after discharge. Delirium, SOFA score and admission BADL disability were significant predictors of in-hospital mortality. SOFA score, CIRS, previous long-term oxygen therapy and discharge BADL dependency significantly predicted post-discharge mortality. The accuracy of SOFA in predicting in-hospital and post-discharge mortality was fair (AUC = 0.685, 95% CI = 0.610-0.761 and AUC = 0.663, 95% CI = 0.593-0.734, respectively). BADL dependency and delirium improved predictive accuracy for in-hospital mortality (ΔAUC = 0.144, 95% CI = 0.062-0.227, p < 0.001), while pre-admission oxygen therapy, CIRS and BADL dependency improved predictivity for 3 month mortality (ΔAUC = 0.177, 95% CI = 0.102-0.252, p < 0.001).

DISCUSSION CONCLUSIONS

Among older pneumonia patients, prognostic stratification obtained by clinical severity indexes is significantly improved by CGA risk factors.

CONCLUSIONS CONCLUSIONS

CGA provides important information for prognostic stratification and clinical management of older pneumonia patients.

Identifiants

DOI: 10.1007/s40520-021-02063-y PMID: 35195875

pubmed: 35195875

doi: 10.1007/s40520-021-02063-y

pii: 10.1007/s40520-021-02063-y

doi:

Substances chimiques

Oxygen S88TT14065

Types de publication

Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

1419-1427

Investigateurs

Filippo Luca Fimognari (FL)

Massimo Rizzo (M)

Olga Cuccurullo (O)

Giovanna Cristiano (G)

Valentina Bambara (V)

Andrea Arone (A)

Andrea Corsonello (A)

Bruno Mazzei (B)

Giorgio Maiuri (G)

Silvio Vena (S)

Giovanni Ruotolo (G)

Alfonso Merante (A)

Giuliano Ceschia (G)

Gabriele Toigo (G)

Francesco Di Grezia (F)

Immacolata Alviggi (I)

Maurizio Luchetti (M)

Rosa Maria Mereu (RM)

Olga Catte (O)

Vittoria Tibaldi (V)

Alberto Ferrari (A)

Luca Carpi (L)

Maria Lia Lunardelli (ML)

Pasquale Vizzo (P)

Emilio Martini (E)

Alfredo Zanatta (A)

Giorgio Gasperini (G)

Chiara Pavan (C)

Francesco De Filippi (F)

Michela Passamonte (M)

Anna Nardelli (A)

Sandra Visioli (S)

Fabrizio Franchi (F)

Marco Masina (M)

Antonio Cherubini (A)

Antonia Scrimieri (A)

Demetrio Postacchini (D)

Roberto Brunelli (R)

Gianfranco Conati (G)

Eleonora Ruberto (E)

Alberto Pilotto (A)

Mario Lo Storto (ML)

Paolo Chioatto (P)

Maria Rita Gulino (MR)

Michele Pagano (M)

Giovanna Crupi (G)

Biagio Ierardi (B)

Bruno Provenzano (B)

Informations de copyright

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