Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients

Motoi Ugajin, Kenichi Yamaki, Natsuko Hirasawa, Takanori Kobayashi, Takeo Yagi Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan Background: The credibility of prognostic indicators in nursing-home-acquired pneumonia (NHAP) is not clear. We previously reported a...

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Autores principales:	Ugajin M, Yamaki K, Hirasawa N, Kobayashi T, Yagi T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	albumin blood urea nitrogen community-acquired pneumonia mortality nursing home-acquired pneumonia severity score Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/6baba242247e4bbcbfa89adc01908944
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spelling	oai:doaj.org-article:6baba242247e4bbcbfa89adc019089442021-12-02T06:10:44ZPrognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients1178-1998https://doaj.org/article/6baba242247e4bbcbfa89adc019089442014-02-01T00:00:00Zhttps://www.dovepress.com/prognostic-value-of-severity-indicators-of-nursing-home-acquired-pneum-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Motoi Ugajin, Kenichi Yamaki, Natsuko Hirasawa, Takanori Kobayashi, Takeo Yagi Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan Background: The credibility of prognostic indicators in nursing-home-acquired pneumonia (NHAP) is not clear. We previously reported a simple prognostic indicator in community-acquired pneumonia (CAP): blood urea nitrogen to serum albumin (B/A) ratio. This retrospective study investigated the prognostic value of severity indicators in NHAP versus CAP in elderly patients. Methods: Patients aged ≥65 years and hospitalized because of NHAP or CAP within the previous 3 years were enrolled. Demographics, coexisting illnesses, laboratory and microbiological findings, and severity scores (confusion, urea, respiratory rate, blood pressure, and age ≥65 [CURB-65] scale; age, dehydration, respiratory failure, orientation disturbance, and pressure [A-DROP] scale; and pneumonia severity index [PSI]) were retrieved from medical records. The primary outcome was mortality within 28 days of admission. Results: In total, 138 NHAP and 307 CAP patients were enrolled. Mortality was higher in NHAP (18.1%) than in CAP (4.6%) (P<0.001). Patients with NHAP were older and had lower functional status and a higher rate of do-not-resuscitate orders, heart failure, and cerebrovascular diseases. The NHAP patients more frequently had typical bacterial pathogens. Using the receiver-operating characteristics curve for predicting mortality, the area under the curve in NHAP was 0.70 for the A-DROP scale, 0.69 for the CURB-65 scale, 0.67 for the PSI class, and 0.65 for the B/A ratio. The area under the curve in CAP was 0.73 for the A-DROP scale, 0.76 for the CURB-65 scale, 0.81 for the PSI class, and 0.83 for the B/A ratio. Conclusion: Patient mortality was greater in NHAP than in CAP. Patient characteristics, coexisting illnesses, and detected pathogens differed greatly between NHAP and CAP. The existing severity indicators had less prognostic value for NHAP than for CAP. Keywords: albumin, blood urea nitrogen, community-acquired pneumonia, mortality, nursing-home-acquired pneumonia, severity scoreUgajin MYamaki KHirasawa NKobayashi TYagi TDove Medical Pressarticlealbuminblood urea nitrogencommunity-acquired pneumoniamortalitynursing home-acquired pneumoniaseverity scoreGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 267-274 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	albumin blood urea nitrogen community-acquired pneumonia mortality nursing home-acquired pneumonia severity score Geriatrics RC952-954.6
spellingShingle	albumin blood urea nitrogen community-acquired pneumonia mortality nursing home-acquired pneumonia severity score Geriatrics RC952-954.6 Ugajin M Yamaki K Hirasawa N Kobayashi T Yagi T Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients
description	Motoi Ugajin, Kenichi Yamaki, Natsuko Hirasawa, Takanori Kobayashi, Takeo Yagi Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan Background: The credibility of prognostic indicators in nursing-home-acquired pneumonia (NHAP) is not clear. We previously reported a simple prognostic indicator in community-acquired pneumonia (CAP): blood urea nitrogen to serum albumin (B/A) ratio. This retrospective study investigated the prognostic value of severity indicators in NHAP versus CAP in elderly patients. Methods: Patients aged ≥65 years and hospitalized because of NHAP or CAP within the previous 3 years were enrolled. Demographics, coexisting illnesses, laboratory and microbiological findings, and severity scores (confusion, urea, respiratory rate, blood pressure, and age ≥65 [CURB-65] scale; age, dehydration, respiratory failure, orientation disturbance, and pressure [A-DROP] scale; and pneumonia severity index [PSI]) were retrieved from medical records. The primary outcome was mortality within 28 days of admission. Results: In total, 138 NHAP and 307 CAP patients were enrolled. Mortality was higher in NHAP (18.1%) than in CAP (4.6%) (P<0.001). Patients with NHAP were older and had lower functional status and a higher rate of do-not-resuscitate orders, heart failure, and cerebrovascular diseases. The NHAP patients more frequently had typical bacterial pathogens. Using the receiver-operating characteristics curve for predicting mortality, the area under the curve in NHAP was 0.70 for the A-DROP scale, 0.69 for the CURB-65 scale, 0.67 for the PSI class, and 0.65 for the B/A ratio. The area under the curve in CAP was 0.73 for the A-DROP scale, 0.76 for the CURB-65 scale, 0.81 for the PSI class, and 0.83 for the B/A ratio. Conclusion: Patient mortality was greater in NHAP than in CAP. Patient characteristics, coexisting illnesses, and detected pathogens differed greatly between NHAP and CAP. The existing severity indicators had less prognostic value for NHAP than for CAP. Keywords: albumin, blood urea nitrogen, community-acquired pneumonia, mortality, nursing-home-acquired pneumonia, severity score
format	article
author	Ugajin M Yamaki K Hirasawa N Kobayashi T Yagi T
author_facet	Ugajin M Yamaki K Hirasawa N Kobayashi T Yagi T
author_sort	Ugajin M
title	Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients
title_short	Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients
title_full	Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients
title_fullStr	Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients
title_full_unstemmed	Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients
title_sort	prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/6baba242247e4bbcbfa89adc01908944
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Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients

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