title: Aspiration pneumonia in old patients with dementia. Prognostic factors of mortality.
abstract: BACKGROUND
  Prognostic factors of mortality in elderly patients with dementia with aspiration pneumonia (AP) are scarcely known. We determined the mortality rate and prognostic factors in old patients with dementia hospitalized due to AP.
  
  
  METHODS
  We prospectively studied 120 consecutive patients aged ≥ 75 years with dementia admitted with AP to two tertiary university hospitals. We collected data on demographic and clinical variables and comorbidities. Oropharyngeal swallowing was assessed by the water swallow test.
  
  
  RESULTS
  Sixty-one (50.8%) patients were female, and mean age was 86 ± 9 years. The swallow test was performed in 68 patients, revealing aspiration in 92.6%. Patients with repeat AP (28.3%) were more-frequently taking thickeners (61.8% vs.11.6%, p<0.0001) and were less-frequently prescribed angiotensin-converting-enzyme (ACE) inhibitors (8.8% vs. 27.9%, p<0.001) than patients with a first episode. Hospital mortality was 33.3%; these patients had lower lymphocyte counts and higher percentage of multilobar involvement. In the multivariate model, involvement of ≥ 2 pulmonary lobes was associated with hospital mortality (OR 3.051, 95% CI 1.248 to 7.458, p<0.01). Six-month mortality was 50.8%; these patients were older and had worse functional capacity and laboratory data indicative of malnutrition. In the multivariate model, lower albumin levels were associated with six-month mortality (OR 1.129, 95% CI 1.008 to 1.265, p<0.03).
  
  
  CONCLUSIONS
  In-hospital and 6-month mortality were high (one-third and one-half patients, respectively). Multilobar involvement and lower lymphocyte counts were associated with hospital mortality, and older age, greater dependence and malnutrition with six-month mortality.
authors.affiliation: Department of Internal Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain. xavbosch@clinic.ub.es
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.forename: Sandra
authors.initials: S
authors.lastname: Cuerpo
authors.forename: Berta
authors.initials: B
authors.lastname: Torres
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rosón
authors.forename: Alfons
authors.initials: A
authors.lastname: López-Soto
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000175:diagnosis / Q000401:mortality*; D003704:Dementia / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D018655:Lymphocyte Count; D008297:Male; D044342:Malnutrition / Q000401:mortality*; D015999:Multivariate Analysis; D011015:Pneumonia, Aspiration / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D012709:Serum Albumin