Influence of Comorbid Conditions on Long-Term Mortality After Pneumonia in Older People
Sachin Yende MD, MS
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorDerek C. Angus MD, MPH
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorIbrahim Sultan Ali MD
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorGrant Somes PhD
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorAnne B. Newman MD, MPH
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorDouglas Bauer MD
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorMelissa Garcia MPH
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorTamara B. Harris MD, MS
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorStephen B. Kritchevsky PhD
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorfor the Health ABC Study
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorSachin Yende MD, MS
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorDerek C. Angus MD, MPH
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorIbrahim Sultan Ali MD
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorGrant Somes PhD
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorAnne B. Newman MD, MPH
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorDouglas Bauer MD
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorMelissa Garcia MPH
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorTamara B. Harris MD, MS
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorStephen B. Kritchevsky PhD
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorfor the Health ABC Study
From the * Clinical Research, Investigation, and Systems Modeling of Acute Illness Laboratory, Department of Critical Care Medicine, and § Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania † Division of Pulmonary and Critical Care ‡ Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee; Departments of ∥ Epidemiology and Biostatistics ¶ Medicine, University of California at San Francisco, San Francisco, California # Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland ** Sticht Center on Aging, Wake Forest University School of Medicine, Winston Salem, North Carolina.
Search for more papers by this authorAbstract
OBJECTIVES: To test the hypothesis that increased long-term mortality after hospitalization for community-acquired pneumonia (CAP) is independent of comorbid conditions.
DESIGN: Prospective observational cohort study in metropolitan areas.
SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania.
PARTICIPANTS: Three thousand seventy-five subjects aged 70 to 79 over 5.2 years.
MEASUREMENTS: Unadjusted and adjusted mortality from an initial hospitalization for CAP were compared with mortality from different causes of hospitalization, including cancer, fracture, congestive heart failure (CHF), cerebrovascular accident (CVA), and other causes. Demographics, smoking, nutritional markers, functional status, inflammatory markers, and chronic health conditions were adjusted for.
RESULTS: Of the 106 subjects hospitalized for CAP, 22 (20.8%) and 38 (35.8%) died at 1 and 5 years. Subjects hospitalized with CAP had higher mortality than nonhospitalized subjects (adjusted odds ratio (OR)=7.8, 95% confidence interval (CI)=4.2–14.4). One- and 5-year mortality after CAP hospitalization were higher than mortality from other causes requiring hospitalization and remained unchanged in multivariable analysis (adjusted OR=3.5, 95% CI=1.5–8.1; adjusted OR=5.6, 95% CI=2.8–11.2, respectively). One- and 5-year mortality after hospitalization for CAP were similar to or higher than mortality after an initial hospitalization for CHF, CVA, or fracture. Rehospitalization was common in subjects hospitalized for CAP and may explain greater long-term mortality.
CONCLUSION: In this high-functioning cohort of older persons, an initial hospitalization for CAP was associated with greater long-term mortality, independent of prehospitalization comorbid conditions. Hospitalization for CAP has as serious a prognosis as hospitalization for CHF, stroke, or major fracture.
REFERENCES
- 1 Kaplan V, Clermont G, Griffin MF et al. Pneumonia: Still the old man's friend? Arch Intern Med 2003; 163: 317–323.
- 2 LaCroix AZ, Lipson S, Miles TP et al. Prospective study of pneumonia hospitalizations and mortality of U.S. older people: The role of chronic conditions, health behaviors, and nutritional status. Public Health Rep 1989; 104: 350–360.
- 3 Brancati FL, Chow JW, Wagener MM et al. Is pneumonia really the old man's friend? Two-year prognosis after community-acquired pneumonia. Lancet 1993; 342: 30–33.
- 4 Koivula I, Sten M, Makela PH. Prognosis after community-acquired pneumonia in the elderly: A population-based 12-year follow-up study. Arch Intern Med 1999; 159: 1550–1555.
- 5 Waterer GW, Kessler LA, Wunderink RG. Medium-term survival after hospitalization with community-acquired pneumonia. Am J Respir Crit Care Med 2004; 169: 910–914.
- 6 Hedlund JU, Ortqvist AB, Kalin ME et al. Factors of importance for the long term prognosis after hospital treated pneumonia. Thorax 1993; 48: 785–789.
- 7 Jokinen C, Heiskanen L, Juvonen H et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993; 137: 977–988.
- 8 Koivula I, Sten M, Makela PH. Risk factors for pneumonia in the elderly. Am J Med 1994; 96: 313–320.
- 9 Yende S, Tuomanen EI, Wunderink RG et al. Pre-infection systemic inflammatory markers and risk of hospitalization due to pneumonia. Am J Respir Crit Care Med 2005; 172: 1440–1446.
- 10 Lung function testing: Selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis 1991; 144: 1202–1218.
- 11 Standardization of spirometry, 1994 Update. American Thoracic Society. Am J Respir Crit Care Med 1995; 152: 1107–1136.
- 12 Levey AS, Bosch JP, Lewis JB et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461–470.
- 13 Teng EL, Chui HC. The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 1987; 48: 314–318.
- 14 Simonsick EM, Newman AB, Nevitt MC et al. Measuring higher level physical function in well-functioning older adults: Expanding familiar approaches in the Health ABC study. J Gerontol A Biol Sci Med Sci 2001; 56: M644–M649.
- 15 Empana JP, Dargent-Molina P, Breart G. Effect of hip fracture on mortality in elderly women: The EPIDOS prospective study. J Am Geriatr Soc 2004; 52: 685–690.
- 16 Hannan EL, Magaziner J, Wang JJ et al. Mortality and locomotion 6 months after hospitalization for hip fracture: Risk factors and risk-adjusted hospital outcomes. JAMA 2001; 285: 2736–2742.
- 17 Collins TC, Petersen NJ, Menke TJ et al. Short-term, intermediate-term, and long-term mortality in patients hospitalized for stroke. J Clin Epidemiol 2003; 56: 81–87.
- 18 Hankey GJ, Jamrozik K, Broadhurst RJ et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 2000; 31: 2080–2086.
- 19 Yende S, Kong L, Weissfeld LA et al. Inflammatory markers prior to hospital discharge predict subsequent mortality after community acquired pneumonia (Abstract). Proc Am Thorac Soc 2006; A836.
- 20 Hansson LO, Hedlund JU, Ortqvist AB. Sequential changes of inflammatory and nutritional markers in patients with community-acquired pneumonia. Scand J Clin Lab Invest 1997; 57: 111–118.
- 21 Cesari M, Penninx BW, Newman AB et al. Inflammatory markers and onset of cardiovascular events: Results from the Health ABC study. Circulation 2003; 108: 2317–2322.
- 22 Bhowmik A, Seemungal TA, Sapsford RJ et al. Relation of sputum inflammatory markers to symptoms and lung function changes in COPD exacerbations. Thorax 2000; 55: 114–120.
- 23 Docke WD, Randow F, Syrbe U et al. Monocyte deactivation in septic patients: Restoration by IFN-gamma treatment. Nat Med 1997; 3: 678–681.
