Marked Reduction in 30-Day Mortality Among Elderly Patients with Community-acquired Pneumonia

Section of Hospital Medicine, University of Chicago, IL 60637, USA.
The American journal of medicine (Impact Factor: 5). 02/2011; 124(2):171-178.e1. DOI: 10.1016/j.amjmed.2010.08.019
Source: PubMed


Community-acquired pneumonia is the most common infectious cause of death in the US. Over the last 2 decades, patient characteristics and clinical care have changed. To understand the impact of these changes, we quantified incidence and mortality trends among elderly adults.
We used Medicare claims to identify episodes of pneumonia, based on a validated combination of diagnosis codes. Comorbidities were ascertained using the diagnosis codes located on a 1-year look back. Trends in patient characteristics and site of care were compared. The association between year of pneumonia episode and 30-day mortality was then evaluated by logistic regression, with adjustment for age, sex, and comorbidities.
We identified 2,654,955 cases of pneumonia from 1987-2005. During this period, the proportion treated as inpatients decreased, the proportion aged ≥80 years increased, and the frequency of many comorbidities rose. Adjusted incidence increased to 3096 episodes per 100,000 population in 1999, with some decrease thereafter. Age/sex-adjusted mortality decreased from 13.5% to 9.7%, a relative reduction of 28.1%. Compared with 1987, the risk of mortality decreased through 2005 (adjusted odds ratio, 0.46; 95% confidence interval, 0.44-0.47). This result was robust to a restriction on comorbid diagnoses assessing for the results' sensitivity to increased coding.
These findings show a marked mortality reduction over time in community-acquired pneumonia patients. We hypothesize that increased pneumococcal and influenza vaccination rates as well as wider use of guideline-concordant antibiotics explain a large portion of this trend.

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    • "Community-acquired pneumonia (CAP) is one of the most common infectious diseases and a major cause of morbidity and mortality worldwide [1], and is the most common infectious cause of death in the developed world [2] [3] with rates as high as 48% [2] [4] [5]. Although CAP can occur at any age, in the past few decades, the epidemiology of CAP has undergone a marked shift and patients are now presenting at an increasingly older age [6]. "
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    ABSTRACT: Community-acquired pneumonia (CAP) is a curable disease. Both the European and American clinical practice guidelines provide algorithms how to manage patients with CAP.However, as populations worldwide are aging and bacteria are becoming multidrug resistant, it is necessary to address the major factors that put patients at risk of poor outcome. These may include age, comorbidities, the settings where pneumonia was acquired or treated, the need for hospitalisation or ICU admission, likely causative pathogen (bacteria or virus) in a certain region and their local susceptibility pattern. One complicating fact is the lack of definite causative pathogen in approximately 50% of patients making it difficult to choose the most appropriate antibiotic treatment. When risk factors are present simultaneously in patients, fewer treatment options could be rather challenging for physicians. For example, the presence of comorbidities (renal, cardiac, hepatic) may exclude certain antibiotics due to potential adverse events.Assessing the severity of the disease and monitoring biomarkers, however, could help physicians to estimate patient prognosis once diagnosis is confirmed and treatment has been initiated. This review article addresses the most important risk factors of poor outcome in CAP patients.
    Respiratory Medicine 11/2014; 109(2). DOI:10.1016/j.rmed.2014.10.018 · 3.09 Impact Factor
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    • "Pneumonia is the most common cause of death for all infectious diseases [1], and together, pneumonia and influenza comprise the eighth leading cause of death in the United States [2]. Much has been done to improve outcomes for patients with pneumonia, including the establishment of national practice guidelines for community-acquired pneumonia [3]. "
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    ABSTRACT: Mortality after pneumonia in immunocompromised patients is higher than for immunocompetent patients. The use of non-invasive mechanical ventilation for patients with severe pneumonia may provide beneficial outcomes while circumventing potential complications associated with invasive mechanical ventilation. The aim of our study was to determine if the use of non-invasive mechanical ventilation in elderly immunocompromised patients with pneumonia is associated with higher all-cause mortality. In this retrospective cohort study, data were obtained from the Department of Veterans Affairs administrative databases. We included veterans age >=65 years who were immunocompromised and hospitalized due to pneumonia. Multilevel logistic regression analysis was used to determine the relationship between the use of invasive versus non-invasive mechanical ventilation and 30-day and 90-day mortality. Of 1,946 patients in our cohort, 717 received non-invasive mechanical ventilation and 1,229 received invasive mechanical ventilation. There was no significant association between all-cause 30-day mortality and non-invasive versus invasive mechanical ventilation in our adjusted model (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.66-1.10). However, those patients who received non-invasive mechanical ventilation had decreased 90-day mortality (OR 0.66, 95% CI 0.52-0.84). Additionally, receipt of guideline-concordant antibiotics in our immunocompromised cohort was significantly associated with decreased odds of 30-day mortality (OR 0.31, 95% CI 0.24-0.39) and 90-day mortality (OR 0.41, 95% CI 0.31-0.53). Our findings suggest that physicians should consider the use of non-invasive mechanical ventilation, when appropriate, for elderly immunocompromised patients hospitalized with pneumonia.
    BMC Pulmonary Medicine 01/2014; 14(1):7. DOI:10.1186/1471-2466-14-7 · 2.40 Impact Factor
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    • "Among Medicare patients who may or may not have been admitted to an ICU, risk adjusted mortality fell by 18% to 46% between 1994 and 2007 [1,2]. Disease specific decreases in the 30-day mortality rate over time have also been reported for patients hospitalized for congestive heart failure (50%, 1993 to 2008) [3], community acquired pneumonia (28%, 1987 to 2005) [4] and surgery for subarachnoid hemorrhage (50%, 1980 to 2005)[5], coronary artery bypass graft (21%, 1999 to 2008) and other high-risk procedures [6]. Changes in hospital mortality have also been reported for US patients with disorders commonly managed in ICUs including sepsis (9.9%, 1979 to 2000) [7], acute lung injury (9%, 1996 to 2005) [8] and surgery for aortic dissection (17%, 1979 to 2003) [9]. "
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    Critical care (London, England) 04/2013; 17(2):R81. DOI:10.1186/cc12695 · 4.48 Impact Factor
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