Influence of comorbid conditions on long-term mortality after pneumonia in older people.
OBJECTIVE
To test the hypothesis that increased long-term mortality after hospitalization for community-acquired pneumonia (CAP) is independent of comorbid conditions.


METHODS
Prospective observational cohort study in metropolitan areas.


METHODS
Memphis, Tennessee, and Pittsburgh, Pennsylvania.


METHODS
Three thousand seventy-five subjects aged 70 to 79 over 5.2 years.


METHODS
Unadjusted and adjusted mortality from an initial hospitalization for CAP were compared with mortality from different causes of hospitalization, including cancer, fracture, congestive heart failure (CHF), cerebrovascular accident (CVA), and other causes. Demographics, smoking, nutritional markers, functional status, inflammatory markers, and chronic health conditions were adjusted for.


RESULTS
Of the 106 subjects hospitalized for CAP, 22 (20.8%) and 38 (35.8%) died at 1 and 5 years. Subjects hospitalized with CAP had higher mortality than nonhospitalized subjects (adjusted odds ratio (OR)=7.8, 95% confidence interval (CI)=4.2-14.4). One- and 5-year mortality after CAP hospitalization were higher than mortality from other causes requiring hospitalization and remained unchanged in multivariable analysis (adjusted OR=3.5, 95% CI=1.5-8.1; adjusted OR=5.6, 95% CI=2.8-11.2, respectively). One- and 5-year mortality after hospitalization for CAP were similar to or higher than mortality after an initial hospitalization for CHF, CVA, or fracture. Rehospitalization was common in subjects hospitalized for CAP and may explain greater long-term mortality.


CONCLUSIONS
In this high-functioning cohort of older persons, an initial hospitalization for CAP was associated with greater long-term mortality, independent of prehospitalization comorbid conditions. Hospitalization for CAP has as serious a prognosis as hospitalization for CHF, stroke, or major fracture.
Yende
Sachin
S
Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. yendes@upmc.edu
Angus
Derek C
DC
Ali
Ibrahim Sultan
IS
Somes
Grant
G
Newman
Anne B
AB
Bauer
Douglas
D
Garcia
Melissa
M
Harris
Tamara B
TB
Kritchevsky
Stephen B
SB
D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000150:complications*; D015897:Comorbidity; D005260:Female; D005853:Geriatrics; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D010359:Patient Readmission; D011014:Pneumonia / Q000150:complications*; D011379:Prognosis