Evaluation of prognostic differences in elderly patients with pneumonia treated by between pulmonologists and non-pulmonologists: a propensity score analysis.
BACKGROUND
The incidence of pneumonia among elderly people is increasing in aged countries, and both pulmonologists and non-pulmonologists treat such patients.


OBJECTIVE
The aim of this study was to assess prognostic differences between elderly patients treated by pulmonologists and those treated by non-pulmonologists.


METHODS
This study was a retrospective cohort using a propensity score analysis. Patients 65 years of age or over with pneumonia were consecutively included. The propensity score was estimated based on the patient's background and severity of pneumonia. The difference in 30-day and 90-day mortality depending on the attending physician's specialty was analyzed after adjusting for other variables, including the propensity score.


RESULTS
We assessed 68 and 182 patients treated by pulmonologists and non-pulmonologists, respectively. The pulmonologists tended to be in charge of patients with hypoxemia, chronic obstructive pulmonary disease or dementia without aspiration pneumonia or renal dysfunction (area under receiver operating characteristic curve to predict treatment by a pulmonologist according to the propensity score = 0.737, P < 0.001). In the multivariate analysis, white blood count cell (adjusted hazard ratio, 1.000, P = 0.030) and the serum albumin level (0.382, P = 0.001) were associated with 30-day mortality, and a bedridden status (3.000, P = 0.013) and the serum albumin level (0.382, P < 0.001) were associated with 90-day mortality; however, the attending physician's specialty was not associated with these prognoses.


CONCLUSIONS
The overall prognosis of pneumonia in elderly patients may not necessarily improve, irrespective of treatment by pulmonologists, and host factors seemed to be associated with mortality.
Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.|Respiratory Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Kosaku
K
Komiya
Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.|Respiratory Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Hiroaki
H
Oka
Respiratory Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Minoru
M
Ohama
Gastrointestinal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Masahiro
M
Uchida
Gastrointestinal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Hajime
H
Miyajima
Nephrology, Tenshindo Hetsugi Hospital, Oita, Japan.
Tomohiko
T
Iwashita
Nephrology, Tenshindo Hetsugi Hospital, Oita, Japan.
Eiji
E
Okabe
Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Osamu
O
Shuto
Internal Medicine, Tenshindo Hetsugi Hospital, Oita, Japan.
Taisuke
T
Matsumoto
Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan.
Hiroshi
H
Ishii
Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Oita, Japan.
Jun-Ichi
J
Kadota
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000473:pathology* / Q000628:therapy*; D011379:Prognosis; D057216:Propensity Score; D015272:Pulmonary Medicine / Q000592:standards; D000072106:Pulmonologists; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors
aspiration; elderly; physician; pneumonia; prognosis