title: Importance of functional assessment in the management of community-acquired and healthcare-associated pneumonia.
abstract: OBJECTIVE
  In Japan, the number of elderly people who have difficulties performing the activities of daily living (ADLs) is increasing. The objective of this study was to assess the relationship between ADL and the clinical characteristics of pneumonia.
  
  
  METHODS
  We conducted a retrospective study of 219 adult patients hospitalized due to pneumonia [151 patients with community-acquired pneumonia (CAP) and 68 patients with healthcare-associated pneumonia (HCAP)]. CAP, HCAP, and all the patients were stratified into two groups using a modified version of the Katz index of five ADLs as follows: independent in all ADLs or dependent in one to three ADLs (CAP-A, HCAP-A, and All-A groups) and dependent in four or five ADLs (CAP-B, HCAP-B, and All-B groups). Disease severity, microbiological findings, and mortality were compared between the groups.
  
  
  RESULTS
  As the ability to perform ADLs declined, A-DROP scores (the CAP severity measurement index) increased significantly in CAP (CAP-A: 1.1±1.1, CAP-B: 2.6±1.1), HCAP (HCAP-A: 2.0±1.0, HCAP-B: 2.8±1.0), and all patients (All-A: 1.3±1.1, All-B: 2.8±1.0). Thirty-day mortality was higher in the CAP-B (23.1%) and All-B (19.2%) groups than in the CAP-A (0.7%) and All-A (1.8%) groups, respectively. A multivariate Cox proportional hazards analysis showed an ADL score ≥ four to be a significant predictor of 30-day mortality in CAP patients [hazard ratio (HR), 19.057; 95% confidence interval (CI), 1.930-188.130] and in all patients (HR, 8.180; 95% CI, 1.998-33.494).
  
  
  CONCLUSIONS
  A functional assessment using a modified version of the Katz index is useful for the management of CAP and HCAP patients.
authors.affiliation: Nijigaoka Hospital, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kosai
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Imamura
authors.forename: Hironori
authors.initials: H
authors.lastname: Tanaka
authors.forename: Misuzu
authors.initials: M
authors.lastname: Tsukamoto
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kurihara
authors.forename: Takahiro
authors.initials: T
authors.lastname: Takazono
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Morinaga
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nakamura
authors.forename: Taiga
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tashiro
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D003428:Cross Infection / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D011014:Pneumonia / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends
chemical_list: D000900:Anti-Bacterial Agents