title: Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients.
abstract: BACKGROUND
  The credibility of prognostic indicators in nursing-home-acquired pneumonia (NHAP) is not clear. We previously reported a simple prognostic indicator in community-acquired pneumonia (CAP): blood urea nitrogen to serum albumin (B/A) ratio. This retrospective study investigated the prognostic value of severity indicators in NHAP versus CAP in elderly patients.
  
  
  METHODS
  Patients aged ≥65 years and hospitalized because of NHAP or CAP within the previous 3 years were enrolled. Demographics, coexisting illnesses, laboratory and microbiological findings, and severity scores (confusion, urea, respiratory rate, blood pressure, and age ≥65 [CURB-65] scale; age, dehydration, respiratory failure, orientation disturbance, and pressure [A-DROP] scale; and pneumonia severity index [PSI]) were retrieved from medical records. The primary outcome was mortality within 28 days of admission.
  
  
  RESULTS
  In total, 138 NHAP and 307 CAP patients were enrolled. Mortality was higher in NHAP (18.1%) than in CAP (4.6%) (P<0.001). Patients with NHAP were older and had lower functional status and a higher rate of do-not-resuscitate orders, heart failure, and cerebrovascular diseases. The NHAP patients more frequently had typical bacterial pathogens. Using the receiver-operating characteristics curve for predicting mortality, the area under the curve in NHAP was 0.70 for the A-DROP scale, 0.69 for the CURB-65 scale, 0.67 for the PSI class, and 0.65 for the B/A ratio. The area under the curve in CAP was 0.73 for the A-DROP scale, 0.76 for the CURB-65 scale, 0.81 for the PSI class, and 0.83 for the B/A ratio.
  
  
  CONCLUSIONS
  Patient mortality was greater in NHAP than in CAP. Patient characteristics, coexisting illnesses, and detected pathogens differed greatly between NHAP and CAP. The existing severity indicators had less prognostic value for NHAP than for CAP.
authors.affiliation: Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan.
authors.forename: Motoi
authors.initials: M
authors.lastname: Ugajin
authors.affiliation: Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yamaki
authors.affiliation: Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Hirasawa
authors.affiliation: Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Yagi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: albumin; blood urea nitrogen; community-acquired pneumonia; mortality; nursing-home-acquired pneumonia; severity score