Predictors of mortality in nursing-home residents with pneumonia: a multicentre study. (January 2018)

• Record Type: Journal Article
• Authors: Falcone, M.; Russo, A.; Gentiloni Silverj, F.; Marzorati, D.; Bagarolo, R.; Monti, M.; Velleca, R.; D'Angelo, R.; Frustaglia, A.; Zuccarelli, G.C.; Prina, R.; Vignati, M.; Marnati, M.G.; Venditti, M.; Tinelli, M.
• Is Part Of: Clinical microbiology and infection. Volume 24:Number 1(2018)
• Page Start: 72
• Page End: 77
• Publication Date: 2018-01
• Subjects: Delirium -- Elderly patient -- Long-term care facility -- Malnutrition -- Nursing-home -- Pneumonia; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2017.05.023
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: To evaluate predictors of mortality in patients residing in nursing-homes (NHs) or long-term care facilities (LTCFs) with diagnosis of NH-acquired pneumonia (NHAP). Methods: We conducted an observational, prospective study (December 2013-December 2015) of patients residing in nine NHs/LTCFs of Central and Northern Italy with diagnosis of NHAP. Data on demographics, comorbidities, microbiology, and therapies were entered into an electronic database. To identify risk factors associated with 30-day mortality, we performed univariable and multivariable analyses, and predictors were internally validated using a bootstrap resampling procedure. We derived a prediction rule using the coefficients obtained from the multivariable logistic regression. The model obtained was assessed using the area under the receiver operating characteristic curve (AUROC). Results: Overall, 446 patients with NHAP were included in the final cohort. The median age was 80 (IQR 75–87) years. A definite aetiology was obtained in 120 (26.9%) patients; of these, 66 (55%) had a culture positive for a multidrug-resistant pathogen. The 30-day mortality was 28.7%. On multivariate analysis, malnutrition (OR 7.8; 95% CI 3–20.2, 2 points), bilateral pneumonia (OR 3.7; 95% CI 1.4–9.8, 1 point), acute mental status deterioration (OR 6.2; 95% CI 2.2–17.6, 2 points), hypotension (OR 7.7; 95% CI 2.3–24.9, 2 points), and PaO2 /FiO2 ratio ≤250 (OR 7.4; 95% CI 2.2–24.2, 2 points) were independently associated with 30-day mortality. The derived prediction rule showed an AUROC of 0.83 (95% CI 0.78–0.87, p <0.001). Conclusions: NH residents with pneumonia have specific risk factors associated with 30-day mortality. Malnutrition and acute mental change appear as major determinants of death in this population.