Premium
Recurrent hospitalisation with pneumonia is associated with higher 1‐year mortality in frail older people
Author(s) -
Ma H. M.,
Yu R. H. Y.,
Woo J.
Publication year - 2013
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12258
Subject(s) - medicine , comorbidity , hazard ratio , pneumonia , proportional hazards model , confidence interval , cohort study , mortality rate
Background Previous studies persistently showed that functional dependence was associated with higher long‐term (≥1 year) mortality of older patients hospitalised with community‐acquired pneumonia ( CAP ). The importance of other factors was, however, not well reported. Aim This study aimed to investigate the relative contributions of comorbidity, nutritional status and frailty to 1‐year mortality. Methods We prospectively recruited older patients, aged ≥65 years, hospitalised with CAP from O ctober 2009 to S eptember 2010 at the Prince of Wales Hospital, H ong K ong. Demographics, C harlson's Comorbidity Index, mid‐arm circumference ( MAC ) and Clinical Frailty Scale ( CFS ) were recorded as baseline characteristics. The severity of pneumonia was evaluated by the CURB score ( c onfusion, blood u rea nitrogen, r espiratory rate and low b lood pressure). The surviving patients were followed for 1 year since discharge to monitor readmission for CAP and all‐cause mortality. We entered the following variables into the multivariate Cox regression model to identify independent predictors of 1‐year all‐cause mortality: age, sex, residential status, MAC , C harlson's Comorbidity Index, CFS and readmission for CAP . Results The final cohort consisted of 428 patients who were discharged from hospital. Within 1 year after hospital discharge, all‐cause mortality and readmission for CAP were 22.4% and 32.0% respectively. Independent predictors of 1‐year mortality were male sex (hazard ratio ( HR ) = 1.57, 95% confidence interval ( CI ) = 1.02–2.48), severe under‐nutrition ( MAC ≤21 cm) ( HR = 3.75, 95% CI = 1.66–8.46), frailty ( CFS ≥5) ( HR = 2.36, 95% CI = 1.29–4.27) and readmission for CAP ( HR = 4.50, 95% CI = 2.82–7.17). Conclusions Recurrent pneumonia may be a terminal life event of frail older people so that advance care planning should be considered in those with recurrent admission for pneumonia.