title: An investigation of multimorbidity measures as risk factors for pneumonia in elderly frail patients admitted to hospital.
abstract: OBJECTIVE
  To investigate the association of different chronic comorbidities, considered singularly and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis in a group of elderly frail hospitalized patients.
  
  
  METHODS
  With a retrospective cohort design, all clinical records of frail (Rockwood ≥ 5) nonterminal patients ≥ 65 years old acutely admitted over a 8-month span in an internal medicine ward were evaluated. Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated, HCAP) were defined according to chest radiology findings and validated criteria. Chronic comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each participant through a standardized methodology. Multivariate logistic regression models were applied to assess the association of each comorbid condition or scores with pneumonia.
  
  
  RESULTS
  1199 patients (546 M, median age 81.9, IQR 72.8-87.9 years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity Score was significantly associated with pneumonia, both at an age- and sex-adjusted model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001-1.062, p=0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41-2.73, p<0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9-3.6, p<0.001) and dementia (OR 2.3, 95% CI 1.7-3.3, p<0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic liver and kidney disease were not.
  
  
  CONCLUSIONS
  In a small cohort of elderly frail hospitalized patients, measures of multimorbidity, like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia are the main conditions concurring to define this risk.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ticinesi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy. Electronic address: antonio.nouvenne@alice.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nouvenne
authors.affiliation: INAIL - CERT Research Center University of Parma, Parma, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Folesani
authors.affiliation: Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Prati
authors.affiliation: Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Morelli
authors.affiliation: Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Guida
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lauretani
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maggio
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Meschi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
keywords: Comorbidity; Cumulative Illness Rating Scale; Frail elderly; Multimorbidity; Pneumonia; Risk factor