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Zhao T, Zhang Y, Wang K, Yu H, Lin L, Qin X, Wu T, Chen D, Wu Y, Hu Y. Identifying Risk Factors for Aspiration in Patients Hospitalized with Community-Acquired Pneumonia. Int J Clin Pract 2023; 2023:2198259. [PMID: 37497126 PMCID: PMC10368512 DOI: 10.1155/2023/2198259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/19/2023] [Accepted: 07/07/2023] [Indexed: 07/28/2023] Open
Abstract
Background Aspiration pneumonia (AP) is difficult to diagnose and has poor outcomes. This case-control study aimed to explore the risk factors and delineate the antibiotic usage for AP. Methods Inpatients diagnosed with community-acquired pneumonia (CAP) from 2013 to 2017, enrolled in the urban employee basic medical insurance program in Beijing, were included and classified into the AP (N = 2,885) and non-AP (N = 53,825) groups. Risk factors were identified by logistic regression. Results Older age (compared to 18-64 years, OR for 65-79 years: 4.3, 95% CI: 3.8-4.9; OR for >80 years: 6.3, 95% CI: 5.6-7.2), male (OR: 1.4, 95% CI: 1.3-1.5), cerebrovascular disease (OR: 3.1, 95% CI: 2.8-3.5), dementia (OR: 2.0, 95% CI: 1.8-2.1), vomiting (OR: 1.4, 95% CI: 1.2-1.7), Parkinson's disease (OR: 2.1, 95% CI: 1.8-2.4), and epilepsy (OR: 3.2, 95% CI: 2.8-3.7) were associated with an increased risk of AP. 92.8% of the AP patients received antibiotic therapy. Among them, patients treated with broad-spectrum antibiotics, antibiotics for injection, and combined antibiotics accounted for 93.3%, 97.9%, and 81.7%, respectively. Conclusions Older age, male, and several comorbidities were independent risk factors for AP, and combined antibiotics treatments are common, which merits attention in accurate detection of AP in a high-risk population.
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Affiliation(s)
- Tianming Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Yi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Kun Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Huan Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
| | - Lianjun Lin
- Geriatric Department, Peking University First Hospital, Beijing 100034, China
| | - Xueying Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Tao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Dafang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Zhang Y, Wang K, Yu H, Zhao T, Lin L, Qin X, Wu T, Chen D, Hu Y, Wu Y. Incidence and characteristics of aspiration pneumonia in adults in Beijing, China, 2011-2017. Public Health 2023; 220:65-71. [PMID: 37270854 DOI: 10.1016/j.puhe.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study aimed to estimate aspiration pneumonia (AP) incidence and describe comorbid characteristics and mortality in Beijing, China. STUDY DESIGN A historical cohort study was conducted based on medical claim records. METHODS Patients admitted with a primary diagnosis of AP were identified from approximately 12 million adults who enrolled in the Urban Employee Basic Medical Insurance program in Beijing, China, from January 2011 to December 2017. The incidences of AP and pneumonia with risk factors for aspiration (PRFA) were estimated by a Poisson distribution. The estimated annual percentage change was reported to represent the average percentage change in incidence per year. Characteristics and 6-month and 1-year all-cause mortality rates for AP and suspected AP patients were described and compared with community-acquired pneumonia (CAP). RESULTS The incidence rates of hospitalized AP and PRFA were 9.4 (95% confidence interval [CI]: 7.6, 11.3) and 102.9 (95% CI: 95.8, 110.3) per 100,000 person-years, respectively. The incidences increased rapidly with age and were stable across the observed years. Patients with AP and PRFA possessed a greater burden of comorbidities than CAP (mean age-adjusted Charlson comorbidity indices for AP: 7.72, PRFA: 7.83, and CAP: 2.84). The 6-month and 1-year all-cause mortality rates for those with AP and PRFA were higher than those for patients with CAP (6-month mortality, AP: 35.2%, PRFA: 21.8%, CAP: 11.1%; 1-year mortality, AP: 42.7%, PRFA: 26.6%, CAP: 13.2%). CONCLUSIONS The incidence of AP and PRFA in Beijing was reported, presenting a full picture of the disease burden. The results provide baseline information for AP prevention.
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Affiliation(s)
- Y Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - K Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - H Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - T Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China
| | - L Lin
- Geriatric Department, Peking University First Hospital, 100034, China
| | - X Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - T Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - D Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China
| | - Y Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China.
| | - Y Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Health Science Center, 100191, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, 100191, China.
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Pneumonia, Aspiration Pneumonia, or Frailty-Associated Pneumonia? Geriatrics (Basel) 2022; 7:geriatrics7050115. [PMID: 36286218 PMCID: PMC9602119 DOI: 10.3390/geriatrics7050115] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Pneumonia is a common reason for admission afflicting frail older adults. Those who are the frailest are more likely to be provided with a diagnosis of aspiration pneumonia. This diagnosis has no clear definition and no clinical consensus. It is therefore time to stop attempting to differentiate between pneumonia type and use the term frailty-associated pneumonia.
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Ikenaga Y, Kusunoki T, Yamaguchi H. Percutaneous Endoscopic Gastrostomy Reduces Aspiration Pneumonia Rate in Stroke Patients with Enteral Feeding in Convalescent Rehabilitation Wards. Prog Rehabil Med 2021; 6:20210031. [PMID: 34514181 PMCID: PMC8387208 DOI: 10.2490/prm.20210031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The effect of percutaneous endoscopic gastrostomy (PEG) on the prevention of aspiration pneumonia and improvements in activities of daily living (ADL) for enteral feeding-dependent stroke patients is unclear. We sought to clarify differences in the rates of aspiration pneumonia and ADL improvement between stroke patients receiving PEG and those receiving nasogastric tube feeding (NGT) in convalescent rehabilitation wards. METHODS We assessed 10 years of data from the Kaga Regional Cooperation Clinical Pathway for Stroke, which covers patients in the southern district of Ishikawa Prefecture of Japan. Logistic regression analysis with propensity score adjustment was used to examine how the enteral feeding method affected aspiration pneumonia rates. Linear regression analysis, adjusted by propensity scores, was also performed to ascertain the effect of the enteral feeding method on ADL improvement. RESULTS Overall, 47 patients with PEG and 49 patients with NGT were analyzed. The incidence of aspiration pneumonia was 4.67 times higher in the NGT group than in the PEG group in the propensity score-adjusted logistic regression analysis (odds ratio 4.67, 95% confidence interval 1.30-16.67, P=0.02). The enteral feeding method had no significant effect on ADL improvement in the propensity score-adjusted linear regression analysis. CONCLUSIONS In convalescent rehabilitation wards, aspiration pneumonia was more likely to occur in stroke patients with NGT than in those with PEG; however, the enteral feeding method did not affect ADL improvement. These results provide a basis for determining the appropriate enteral feeding method for stroke patients who cannot take adequate nutrition orally during convalescence/rehabilitation.
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Affiliation(s)
- Yasunori Ikenaga
- Department of Rehabilitation Medicine, Yawata Medical Center, Ishikawa, Japan
- Council of Kaga Local Stroke Network, South Ishikawa, Japan
| | | | - Hiromi Yamaguchi
- Department of Rehabilitation Medicine, Yawata Medical Center, Ishikawa, Japan
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Chen XR, Wang DX. Serum MCP-1 and NGAL Play an Important Role in the Acute Inflammatory Event of Chronic Obstructive Pulmonary Disease. COPD 2021; 18:425-431. [PMID: 34325599 DOI: 10.1080/15412555.2021.1954151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
NGAL is mainly secreted by neutrophils which play the core role in AECOPD. MCP-1 is secreted specifically by monocytes and macrophages. Both biomarkers are involved in the core process of acute inflammatory reaction in COPD. So We analyzed serum NGAL and MCP-1levels to explore their potential clinical values in the chronic obstructive pulmonary disease (COPD) .This study enrolled 97 COPD patients and 50 healthy controls. All participants received blood collection and lung function test and arterial blood gas measurements. The expression levels of serum NGAL and MCP-1 were measured by ELISA. The serum NGAL and MCP-1 levels of COPD with community-acquired pneumonia (COPD-CAP) patients were significantly higher than those of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients and healthy adults. The NGAL levels of the GOLD III and IV groups were significantly higher than those of the GOLD II group. Spearman correlation analysis showed a negative correlation between NGAL and FEV1%pred, FVC% pred. ROC curves indicated that NGAL has a high diagnostic value for both AECOPD and COPD-CAP. NGAL has the value of distinguishing GOLD I and II from GOLD III and IV. MCP-1 have moderate diagnostic value for COPD-CAP and can differentiate COPD-CAP from AECOPD. This study shows NGAL has certain diagnostic value for AECOPD and COPD-CAP, but can not distinguish the two. NGAL is closely related to airway remodeling and can be used as a potential indicator to distinguish the higher GOLD degree. MCP-1 can be used as potential indicator for the diagnosis of COPD-CAP.
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Affiliation(s)
- Xing-Ru Chen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dao-Xin Wang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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6
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Liu HX, Cui N, Li YF. Review on the correlation between chronic obstructive pulmonary disease and eosinophil in peripheral blood. EUR J INFLAMM 2021. [DOI: 10.1177/2058739221998183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an irreversible disease characterized by the limitation of continuous airflow. Eosinophil (EOS) in peripheral blood plays a key role in the acute exacerbation of COPD. Eosinophil-increased COPD has become an important variant of COPD and the focus of individualized treatment of COPD. Numerous studies have shown that an increased eosinophil count or an increased percentage in the peripheral blood closely correlates to the acute exacerbation and prognosis of COPD. Therefore, this study intends to review the progress of domestic and foreign research on the correlation between COPD and EOS.
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Affiliation(s)
- Hong-Xiang Liu
- Department of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Hebei University, Baoding, China
| | - Na Cui
- Department of ICU, Affiliated hospital of Hebei University, Baoding, China
| | - Yi-Fan Li
- Department of Integrated Traditional Chinese and Western Medicine, Affiliated Hospital of Hebei University, Baoding, China
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Miya C, Cueno ME, Suzuki R, Maruoka S, Gon Y, Kaneko T, Yonehara Y, Imai K. Porphyromonas gingivalis gingipains potentially affect MUC5AC gene expression and protein levels in respiratory epithelial cells. FEBS Open Bio 2020; 11:446-455. [PMID: 33332733 PMCID: PMC7876492 DOI: 10.1002/2211-5463.13066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/02/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023] Open
Abstract
Porphyromonas gingivalis (Pg) is a periodontopathic pathogen that may affect MUC5AC‐related mucus hypersecretion along airway epithelial cells. Here, we attempted to establish whether Pg virulence factors (lipopolysaccharide, FimA fimbriae, gingipains) affect MUC5AC in immortalized and primary bronchial cells. We report that MUC5AC gene expression and protein levels are affected by Pg culture supernatant, but not by lipopolysaccharide or FimA fimbriae. Cells treated with either Pg single (Kgp or Rgp) or double (Kgp/Rgp) mutants had altered levels of MUC5AC gene expression and protein levels, and MUC5AC staining of double mutant‐treated mouse lung cells showed that MUC5AC protein levels were unaffected. Taken together, we propose that Pg gingipains may be the primary virulence factor that influences both MUC5AC gene expression and protein levels.
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Affiliation(s)
- Chihiro Miya
- Department of Oral and Maxillofacial Surgery II, Nihon University School of Dentistry, Tokyo, Japan.,Department of Microbiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Marni E Cueno
- Department of Microbiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Ryuta Suzuki
- Department of Oral and Maxillofacial Surgery II, Nihon University School of Dentistry, Tokyo, Japan.,Department of Microbiology, Nihon University School of Dentistry, Tokyo, Japan
| | - Shuichiro Maruoka
- Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuhiro Gon
- Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tadayoshi Kaneko
- Department of Oral and Maxillofacial Surgery II, Nihon University School of Dentistry, Tokyo, Japan
| | - Yoshiyuki Yonehara
- Department of Oral and Maxillofacial Surgery II, Nihon University School of Dentistry, Tokyo, Japan
| | - Kenichi Imai
- Department of Microbiology, Nihon University School of Dentistry, Tokyo, Japan
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8
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Shin B, Kim SH, Yong SJ, Lee WY, Park S, Lee SJ, Lee SJ, Lee MK. Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary disease with community-acquired pneumonia. Chron Respir Dis 2020; 16:1479972318809480. [PMID: 30428701 PMCID: PMC6301835 DOI: 10.1177/1479972318809480] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. Pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes. We performed a prospective cohort study to evaluate the prognosis of AECOPD patients with or without community-acquired pneumonia (CAP) who hospitalized from January 2012 to December 2015. We investigated mortality and readmission rates within 6 months after the first admission between two groups and analyzed the difference of survival rate according to readmission duration (≤30 vs. >30 days) or intensive care unit (ICU) treatment. Total 308 AECOPD patients (134 with CAP and 174 without CAP) were enrolled. The mean age was 72.3 ± 9.5 years old, and 235 patients (76.3%) were male. The 180-day mortality was higher in AECOPD with CAP than without CAP (24.6% vs. 13.2%; hazard ratio (HR): 1.982; 95% CI: 1.164–3.375; p = 0.012). However, readmission rate showed no significant difference between two groups (51.5% vs. 46.6%; HR: 1.172; 95% CI: 0.850–1.616; p = 0.333). It showed a significantly lower survival rate in AECOPD with CAP rather than without CAP when were readmitted within 30 days (HR: 1.738; 95% CI:1.063–3.017; p = 0.031). According to ICU treatment, survival rate was not significantly different between two groups. Multivariate analysis revealed the readmission within 30 days (p < 0.001), serum hemoglobin concentration (p = 0.010), and albumin level (p = 0.049) were significantly associated with 180-day mortality of AECOPD with CAP. AECOPD with CAP showed lower survival rate than AECOPD without CAP during 6 months. Early readmission within 30 days was significantly associated with an increased risk of mortality.
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Affiliation(s)
- Beomsu Shin
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Sang-Ha Kim
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Suk Joong Yong
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Won-Yeon Lee
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Sunmin Park
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Sang Jun Lee
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Seok Jeong Lee
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
| | - Myoung Kyu Lee
- 1 Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea.,2 Department of Evidence Based Medicine, Wonju College of Medicine, Yonsei University, Gangwon, Korea
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9
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Park S, Lee SJ, Shin B, Lee SJ, Kim SH, Kwon WC, Kim J, Lee MK. The association of delta neutrophil index with the prognosis of acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 2020; 20:47. [PMID: 32075629 PMCID: PMC7031980 DOI: 10.1186/s12890-020-1083-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/11/2020] [Indexed: 01/02/2023] Open
Abstract
Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is associated with infective triggers including bacterial or viral in many cases, and pneumonia is a major contributor to hospitalization for AECOPD and has a close relationship with poor outcomes. Increased delta neutrophil index (DNI) can be useful in the detection of COPD patients with pneumonia. Methods A retrospective cohort study was performed to investigate the mortality rate of the patients who were re-admitted within 6 months after discharge from the hospital due to AECOPD with or without CAP. We analyzed the difference of cumulative survival rate according to serum DNI level and readmission duration. Results Finally, 140 AECOPD patients with community-acquired pneumonia (CAP) and 174 AECOPD patients without CAP were enrolled during 6 months, respectively. The mean age was 72.2 ± 9.4 year-old, and 240 patients (76.4%) were male. When comparing the cumulative survival rate according to readmission duration (≤ 30 vs > 30 days) and DNI level (< 3.5 vs ≥ 3.5%), AECOPD patients with readmission ≤30 days and DNI ≥ 3.5% showed the lowest cumulative survival rate compared to other groups (P < 0.001). Multivariate analysis revealed readmission duration ≤30 days (HR 7.879, 95% CI 4.554–13.632, P < 0.001); and serum DNI level (HR 1.086, 95% CI 1.043–1.131, P < 0.001) were significantly associated with the mortality of AECOPD patients during 6 months. The area under the curve for readmission (≤ 30 days) + DNI level (≥ 3.5%) was 0.753 (95% CI 0.676–0.830, P < 0.001) with a sensitivity of 73.7% and a specificity of 67.3%. Conclusion AECOPD patients who were readmitted ≤30 days and DNI ≥ 3.5% showed higher mortality. DNI level can be used as a predictor of prognosis in AECOPD patients who were readmitted after discharge.
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Affiliation(s)
- Sunmin Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
| | - Sang Jun Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
| | - Beomsu Shin
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea
| | - Woo Cheol Kwon
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Gangwon, South Korea
| | - Jihye Kim
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Ilsan-dong, Wonju-si, Gangwon-do, 26426, South Korea. .,Department of Evidence based medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon, South Korea.
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10
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Jo T, Yasunaga H, Michihata N, Sasabuchi Y, Hasegawa W, Takeshima H, Sakamoto Y, Matsui H, Fushimi K, Nagase T, Yamauchi Y. Influence of Parkinsonism on outcomes of elderly pneumonia patients. Parkinsonism Relat Disord 2018; 54:25-29. [PMID: 29627432 DOI: 10.1016/j.parkreldis.2018.03.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/24/2018] [Accepted: 03/27/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Pneumonia is one of the most frequent reasons for hospitalization in patients with Parkinson's disease. The present study aimed to evaluate the impact of Parkinsonism on the clinical courses of elderly patients hospitalized for pneumonia. METHODS We conducted a retrospective cohort study of patients aged ≥60 years who were hospitalized for pneumonia, using data from a national inpatient database in Japan. We performed one-to-four matching for age and sex between patients with and without Parkinsonism. Multivariable regression analyses were carried out for in-hospital mortality, length of stay, and discharge to home. RESULTS Patients with Parkinsonism had significantly lower in-hospital mortality than those without Parkinsonism (odds ratio, 0.81; 95% confidence interval, 0.74-0.89). Length of stay was 8.1% longer in patients with Parkinsonism. Patients with Parkinsonism were less likely to be discharged to home (odds ratio, 0.62; 95% confidence interval, 0.58-0.67). CONCLUSION Parkinsonism was not an independent predictor of in-hospital mortality, but was related to prolonged length of stay and discharge other than to home in patients with pneumonia.
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Affiliation(s)
- Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, Japan
| | | | - Wakae Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine, Japan
| | | | - Yukiyo Sakamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, Japan
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11
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Dai RX, Kong QH, Mao B, Xu W, Tao RJ, Wang XR, Kong QY, Xu JF. The mortality risk factor of community acquired pneumonia patients with chronic obstructive pulmonary disease: a retrospective cohort study. BMC Pulm Med 2018; 18:12. [PMID: 29357862 PMCID: PMC5778745 DOI: 10.1186/s12890-018-0587-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/15/2018] [Indexed: 11/26/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in community acquired pneumonia (CAP) patients. We aimed to investigate the characteristics and mortality risk factors of COPD patients hospitalized with CAP. Methods A retrospective cohort study was conducted at Shanghai Pulmonary Hospital and Shanghai Dahua Hospital. Clinical and demographic data in patients diagnosed with CAP were collected between January 2015 and June 2016. Logistic regression analysis was performed to screen mortality risk factors of COPD patients hospitalized with CAP. Results Of the total 520 CAP patients, 230 (44.2%) patients had been diagnosed comorbid with COPD (COPD-CAP). CAP patients comorbid with COPD patients had higher rate of need for ICU admission (18.3% vs 13.1%) and need for NIMV (26.1% vs 1.4%) than without COPD (nCOPD-CAP). The PSI, CURB-65 and APACHE-II scores in COPD-CAP patients were higher than that in nCOPD-CAP patients (95 vs 79, P < 0.001; 1 vs 1, P < 0.001; 13 vs 8, P < 0.001, respectively). Logistic regression analysis indicated that aspiration, D-dimer > 2.0 μg/mL and CURB-65 ≥ 3 were risk factors associated with in-hospital mortality ((odd ratio) OR = 5.678, OR = 4.268, OR = 20.764, respectively) in COPD-CAP patients. The risk factors associated with 60-day mortality in COPD-CAP patients were comorbid with coronary heart disease, aspiration, need for NIMV (non-invasive mechanical ventilation) and CURB-65 ≥ 3 (OR = 5.206, OR = 7.921, OR = 3.974, OR = 18.002, respectively). Conclusions COPD patients hospitalized with CAP had higher rate of need for NIMV, need for ICU admission and severity scores than those without COPD. Aspiration, D-dimer > 2.0 μg/mL, comorbid with coronary heart disease, need for NIMV and CURB-65 ≥ 3 were mortality risk factors in CAP patients comorbid with COPD. Electronic supplementary material The online version of this article (10.1186/s12890-018-0587-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruo-Xuan Dai
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Qing-Hua Kong
- Department of Respiratory and Critical Care Medicine, Shanghai Dahua Hospital, No. 901 Old Humin Road, Shanghai, China
| | - Bei Mao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Wen Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Ru-Jia Tao
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China
| | - Xiao-Ru Wang
- Department of Respiratory and Critical Care Medicine, Shanghai Dahua Hospital, No. 901 Old Humin Road, Shanghai, China
| | - Qing-Yao Kong
- Department of Anesthesia and Critical Care, the University of Chicago, Chicago, IL, USA
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai, 200433, China.
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12
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Preoperative Pulmonary Function Tests Predict Aspiration Pneumonia After Gastric Endoscopic Submucosal Dissection. Dig Dis Sci 2017; 62:3084-3090. [PMID: 28879570 DOI: 10.1007/s10620-017-4750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/01/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND ESD allows higher rates of en-bloc and R0 resections, but has occasionally complications such as aspiration pneumonia. Factors associated with aspiration pneumonia are not completely understood. AIMS To analyze the relationship between aspiration pneumonia and preoperative factors including pulmonary function tests. METHODS A total of 978 patients with gastric tumors who had received pulmonary function tests were treated by ESD between June 2006 and May 2014. Pulmonary function tests were assessed using a spirometer. The patients were categorized into four groups according to the predicted vital capacity (%VC) and forced expiratory volume in 1 s as a percentage of forced vital capacity (FEV1.0%): normal; restrictive pulmonary dysfunction; obstructive; and mixed. The factors associated with aspiration pneumonia were retrospectively analyzed. RESULTS Among the 268 cases with abnormal pulmonary function, 10 cases (3.7%) developed aspiration pneumonia. On the other hand, 7 cases (1.0%) with normal pulmonary function developed pneumonia. There was a significant correlation between pulmonary function and aspiration pneumonia (p = 0.010). When the pulmonary function cases were stratified into subgroups, 2.5% of cases with obstructive pulmonary dysfunction developed pneumonia, 5.5% with restrictive and 5.3% with mixed. By logistic regression analysis, pulmonary function, the presence of cerebral vascular disease, and procedure time were identified as significant independent risk factors associated with aspiration pneumonia. The odds ratios for pulmonary function, cerebral vascular disease, and procedure time were 3.6, 5.1, and 5.2, respectively. CONCLUSIONS Preoperative pulmonary function tests may be useful markers to evaluate the risk for aspiration pneumonia after gastric ESD.
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Jo T, Yasunaga H, Sasabuchi Y, Michihata N, Morita K, Yamauchi Y, Hasegawa W, Takeshima H, Sakamoto Y, Matsui H, Fushimi K, Nagase T. Association between dementia and discharge status in patients hospitalized with pneumonia. BMC Pulm Med 2017; 17:128. [PMID: 28985724 PMCID: PMC6389218 DOI: 10.1186/s12890-017-0473-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/02/2017] [Indexed: 02/20/2023] Open
Abstract
Background Pneumonia is the most common cause of death in patients with dementia, but the outcomes of patients with dementia hospitalized with pneumonia are poorly understood. We sought to illuminate the association between dementia and in-hospital mortality and discharge status in patients hospitalized with pneumonia. Methods We used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify retrospectively patients aged ≥60 years admitted to hospital with pneumonia during the study period of May 1, 2010 to March 31, 2014. We recorded their sex, age, body mass index, severity of pneumonia and comorbidities (including dementia). The outcomes were in-hospital mortality and discharge home. Multivariable Cox regression analysis was performed to analyze factors influencing discharge home. Results We identified 470,829 patients hospitalized with pneumonia; 45,031 were recorded as having dementia (9.6%). In-hospital mortality was 13.1% and 13.4% in patients with and without dementia, respectively (P = 0.63). The proportions of patients discharged home were 52.9% and 71.3% in patients with and without dementia, respectively (P < 0.001). The adjusted hazard ratio for discharge home for patients with dementia was 0.68 (95% confidence interval, 0.67–0.69; P < 0.001). Conclusions In-hospital mortality from pneumonia did not differ significantly between patients with and without dementia; however, those with dementia were less likely to be discharged home.
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Affiliation(s)
- Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan. .,Department of Respiratory Medicine, Graduate School of Medicine, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sasabuchi
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, Tokyo, Japan
| | - Wakae Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine, Tokyo, Japan
| | - Hideyuki Takeshima
- Department of Respiratory Medicine, Graduate School of Medicine, Tokyo, Japan
| | - Yukiyo Sakamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, Tokyo, Japan
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14
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Palacios-Ceña D, Hernández-Barrera V, López-de-Andrés A, Fernández-de-Las-Peñas C, Palacios-Ceña M, de Miguel-Díez J, Carrasco-Garrido P, Jiménez-García R. Time trends in incidence and outcomes of hospitalizations for aspiration pneumonia among elderly people in Spain (2003-2013). Eur J Intern Med 2017; 38:61-67. [PMID: 28065660 DOI: 10.1016/j.ejim.2016.12.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Aspiration pneumonia (AP) is an infectious process causing high rates of mortality. The purpose of this study was: 1, to describe the incidence from 2003 to 2013 of AP hospitalizations; 2, to assess time trends in hospital outcomes variables, and; 3, to identify the factors independently associated with in-hospital mortality (IHM). METHODS A retrospective observational study using the Spanish National Hospital Database, with patients discharged between January 2003 and December 2013 was conducted. Inclusion criteria were: Subjects aged 75years or older whose medical diagnosis included AP events code according to the ICD-9-CM: 507.x in the primary diagnosis field. Patient variables, up to 14 discharge diagnoses per patient, and up to 20 procedures performed during the hospital stay (ICD-9-CM), Charlson Comorbidity Index, readmission, length of hospital stay (LOHS), and IHM were analyzed. RESULTS We included 111,319 admissions (53.13% women). LOHS decreased in both sexes (P<0.001) and was significantly higher in men (10.4±10.31 vs. 9.56±10.02days). Readmissions increased significantly in women during the study (13.94% in 2003 to 16.41% in 2013, P<0.001). In both sex, IHM was significantly higher in >94years old subjects (OR: 1.43, 95%CI 1.36-1.51) and in those with readmissions (OR: 1.20, 95%CI 1.15-1.23). For the entire population, time trend analyses showed a significant decrease in mortality from 2003 to 2013 (OR: 0.96, 95%CI 0.95-0.97). CONCLUSIONS Patients with AP are older, male, and have more comorbidities than those without AP. Over time, LOHS and IHM decreased in both sexes, but readmissions increased significantly in women.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Ana López-de-Andrés
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - César Fernández-de-Las-Peñas
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - María Palacios-Ceña
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - Pilar Carrasco-Garrido
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Rodrigo Jiménez-García
- Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Medical Microbiology and Immunology and Nursing Department, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
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Lu Z, Cheng Y, Tu X, Chen L, Chen H, Yang J, Wang J, Zhang L. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units. Int J Chron Obstruct Pulmon Dis 2016; 11:1867-72. [PMID: 27563239 PMCID: PMC4984991 DOI: 10.2147/copd.s113510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. PATIENTS AND METHODS A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann-Whitney U-test. Kaplan-Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox's proportional hazards regression model was performed to identify risk factors for multivariate analysis. RESULTS A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, P<0.05). Kaplan-Meier survival analysis showed that patients with CAP had a worse survival rate than patients without CAP (P<0.05). Clinical characteristics, including Acute Physiology and Chronic Health Evaluation II (APACHE II) score, C-reactive protein, and CAP, were found to be closely associated with survival of AECOPD individuals. Further multivariate Cox regression analysis confirmed that CAP and APACHE II were independent risk factors for inhospital mortality in critically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50-18.47, P<0.01 and APACHE II: hazard ratio, 1.20; 95% CI, 1.06-1.37, P<0.01). CONCLUSION CAP may be an independent risk factor for higher inhospital mortality in critically ill AECOPD patients.
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Affiliation(s)
- Zhiwei Lu
- Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Yusheng Cheng
- Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Xiongwen Tu
- Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Liang Chen
- Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Hu Chen
- Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Jian Yang
- Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Jinyan Wang
- Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
| | - Liqin Zhang
- Department of Respiratory Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, People's Republic of China
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16
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Yamauchi Y, Yasunaga H, Hasegawa W, Sakamoto Y, Takeshima H, Jo T, Matsui H, Fushimi K, Nagase T. Effect of outpatient therapy with inhaled corticosteroids on decreasing in-hospital mortality from pneumonia in patients with COPD. Int J Chron Obstruct Pulmon Dis 2016; 11:1403-11. [PMID: 27382276 PMCID: PMC4922764 DOI: 10.2147/copd.s107985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background and objectives Inhaled corticosteroids (ICS) and long-acting inhaled bronchodilators (IBD) are beneficial for the management of COPD. Although ICS has been reported to increase the risk of pneumonia in patients with COPD, it remains controversial whether it influences mortality. Using a Japanese national database, we examined the association between preadmission ICS therapy and in-hospital mortality from pneumonia in patients with COPD. Methods We retrospectively collected data from 1,165 hospitals in Japan on patients with COPD who received outpatient inhalation therapy and were admitted with pneumonia. Patients were categorized into those who received ICS with IBD and those who received IBD alone. We performed multivariate logistic regression analysis to examine the association between outpatient ICS therapy and in-hospital mortality, adjusting for the patients’ backgrounds. Results Of the 7,033 eligible patients, the IBD alone group (n=3,331) was more likely to be older, have lower body mass index, poorer general conditions, and more severe pneumonia than the ICS with IBD group (n=3,702). In-hospital mortality was 13.2% and 8.1% in the IBD alone and the ICS with IBD groups, respectively. After adjustment for patients’ backgrounds, the ICS with IBD group had significantly lower mortality than the IBD alone group (adjusted odds ratio, 0.80; 95% confidence interval, 0.68–0.94). Higher mortality was associated with older age, being male, lower body mass index, poorer general status, and more severe pneumonia. Conclusion Outpatient inhaled ICS and IBD therapy was significantly associated with lower mortality from pneumonia in patients with COPD than treatment with IBD alone.
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Affiliation(s)
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health
| | - Wakae Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine
| | - Yukiyo Sakamoto
- Department of Respiratory Medicine, Graduate School of Medicine
| | | | - Taisuke Jo
- Department of Respiratory Medicine, Graduate School of Medicine; Division for Health Service Promotion, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine
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17
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Gross RD, Prigent H. Chronic Obstructive Pulmonary Disease and Occult Aspiration: A Review of the Recent Literature. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Akuzawa N, Naito H. Nutritional parameters affecting severity of pneumonia and length of hospital stay in patients with pneumococcal pneumonia: a retrospective cross-sectional study. BMC Pulm Med 2015; 15:149. [PMID: 26608261 PMCID: PMC4658754 DOI: 10.1186/s12890-015-0143-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/18/2015] [Indexed: 12/02/2022] Open
Abstract
Background Pneumococcal pneumonia is the most common form of community-acquired pneumonia (CAP). Although a pneumococcal conjugate vaccine has contributed to a reduction in the incidence of pneumococcal pneumonia among older children and adults, no significant decrease in the incidence has been observed among persons aged ≥65 years. A low body mass index and hypoalbuminemia are common in Japanese patients with CAP, but the association of other nutritional parameters with the severity of pneumonia or length of hospital stay in patients with pneumococcal pneumonia is unclear. Methods Fifty-seven previously healthy inpatients who presented with pneumococcal pneumonia were divided into two groups: those aged ≥65 years (n = 36) and those aged <65 years (n = 21). Patients’ characteristics (the Confusion, Urea, Respiratory rate, Blood pressure, age >65 years (CURB-65) score), the pneumonia severity index (PSI), and inflammatory and metabolic nutritional parameters were compared between the two groups. Results The older group showed significantly lower serum albumin and cholinesterase (ChE) levels. Multivariate linear regression analysis revealed that the PSI was positively correlated with age in both groups. In the younger age group, both the CURB-65 score and PSI showed significant negative correlations with the serum ChE level, and there was a significant negative correlation between the length of stay and serum total cholesterol (T-cho) level. In the older group, the fasting period, lymphocyte count, and age showed significant positive correlations with the length of stay. There was a significant negative correlation between the length of stay and serum albumin level, but no correlation with the serum ChE or T-cho levels, in the older patients. Conclusions Our findings suggest that in patients aged <65 years, age and serum ChE and T-cho levels were associated with both the severity of pneumococcal pneumonia and length of stay. In contrast, the length of stay in older patients was associated with multiple factors that differed from those in younger patients. These differences may reflect age-related immunosenescence in older patients and a greater effect of serum ChE and T-cho levels on immunity in younger patients.
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Affiliation(s)
- Nobuhiro Akuzawa
- Nutrition Support Team, Gunma Chuo Hospital, 1-7-13 Koun-cho, Maebashi, Gunma, 371-0025, Japan.
| | - Hiroshi Naito
- Nutrition Support Team, Gunma Chuo Hospital, 1-7-13 Koun-cho, Maebashi, Gunma, 371-0025, Japan.
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