title: Influence of comorbid conditions on long-term mortality after pneumonia in older people.
abstract: 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.
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. yendes@upmc.edu
authors.forename: Sachin
authors.initials: S
authors.lastname: Yende
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: Ibrahim Sultan
authors.initials: IS
authors.lastname: Ali
authors.forename: Grant
authors.initials: G
authors.lastname: Somes
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Douglas
authors.initials: D
authors.lastname: Bauer
authors.forename: Melissa
authors.initials: M
authors.lastname: Garcia
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
mesh_terms: 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