Short-term mortality among older persons hospitalized for pneumonia: influence of baseline patient characteristics beyond severity of illness.
BACKGROUND
Although severity of illness indices such as pneumonia severity index (PSI) are good predictors of short-term mortality for community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP), other patient factors may have added prognostic value.


OBJECTIVE
To identify patient factors beyond the PSI which explain 30-day mortality among older persons hospitalized with CAP and HCAP.


METHODS
Retrospective cohort study.


METHODS
Three acute care hospitals in Singapore in 2007.


METHODS
Hospitalized adults aged 65 years or older who have primary International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes 480 to 486 with clinical and radiological features of pneumonia.


METHODS
None.


METHODS
Thirty-day mortality, PSI class, demographic and clinical features, comorbid conditions, functional status, selected laboratory tests, and chest radiographic findings.


RESULTS
Among 1607 patients included, 890 (55.4%) had CAP and 717 (44.6%) had HCAP. After adjustment for PSI class in logistic regression analyses, pre-morbid ambulation impairment (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.98 to 3.45), hospitalization in the prior 30 days (OR 1.93, 95% CI 1.38 to 2.71), and absence of cough and purulent sputum (OR 1.47, 95% CI 1.14 to 1.90) were all significantly associated with 30-day mortality. These associations remained constant when CAP and HCAP were analyzed separately.


CONCLUSIONS
Recent hospitalization, pre-morbid ambulation impairment, and atypical presentation were independently associated with higher 30-day mortality among older persons hospitalized for pneumonia, after adjusting for severity of illness. These factors could be considered in addition to PSI when performing risk stratification and adjustment in this setting.
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore. dyyttsh@gmail.com
Yew Y
YY
Ding
John
J
Abisheganaden
Wai F
WF
Chong
Bee H
BH
Heng
T K
TK
Lim
D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008485:Medical Audit; D011014:Pneumonia / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology