Prognostic factors of 90-day mortality in older people with healthcare-associated pneumonia.

ABSTRACT

AIM: The Quick Sequential Organ Failure Assessment, and confusion, urea, respiratory rate, blood pressure and age (CURB-65) scores have been used as prognostic factors of mortality related to healthcare-associated pneumonia. However, aspiration pneumonia remains unclear. METHODS: A cross-sectional, prospective cohort study was carried out with 130 inpatients aged ≥75 years at a Geriatric ward of Kyorin University Hospital, Japan. We investigated the utility of aspiration pneumonia-related factors, latency of swallowing reflex and cough reflex sensitivity, serum albumin levels, the neutrophil-to- lymphocyte ratio, and conventional scores of pneumonia severity, for predicting 30- and 90-day healthcare-associated pneumonia mortality. Patient demographics, cognition, physical activity (Barthel Index), eating ability (Food Intake Level Scale), dementia stage (Functional Assessment Staging Tool), performance status (Zubrod score), current medications and comorbidities were collected. Pneumonia severity was evaluated using the Quick Sequential Organ Failure Assessment, CURB-65 and Systemic Inflammatory Response Syndrome criteria scores. RESULTS: Age, Barthel Index, Zubrod, Functional Assessment Staging Tool and Food Intake Level Scale scores were significantly associated with mortality, whereas the conventional scores were not. The Kaplan-Meier method with the log-rank test using Cox proportional hazards analysis showed that serum albumin levels <2.75 and the comorbidity of atrial fibrillation were associated with a lower survival rate in deceased versus surviving individuals at 90 days. In addition, a deteriorated latency of swallowing reflex and a blunted cough reflex sensitivity were associated with 90-day mortality. CONCLUSIONS: Hypoalbuminemia, atrial fibrillation, deteriorated latency of swallowing reflex and blunted cough reflex sensitivity values were better predictors of 90-day mortality than traditional scores in older individuals with healthcare-associated pneumonia. Geriatr Gerontol Int 2020; 20 1036-1043..