Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study
Abstract Background Mortality prediction of pneumonia by severity scores in patients with multiple underlying health conditions has not fully been investigated. This prospective cohort study is to identify mortality-associated underlying health conditions and to analyse their influence on severity-b...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12890-018-0648-y |
| _version_ | 1818839373903298560 |
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| author | Sugihiro Hamaguchi Motoi Suzuki Kota Sasaki Masahiko Abe Takao Wakabayashi Eiichiro Sando Makito Yaegashi Shimpei Morimoto Norichika Asoh Naohisa Hamashige Masahiro Aoshima Koya Ariyoshi Konosuke Morimoto on behalf of The Adult Pneumonia Study Group – Japan |
| author_facet | Sugihiro Hamaguchi Motoi Suzuki Kota Sasaki Masahiko Abe Takao Wakabayashi Eiichiro Sando Makito Yaegashi Shimpei Morimoto Norichika Asoh Naohisa Hamashige Masahiro Aoshima Koya Ariyoshi Konosuke Morimoto on behalf of The Adult Pneumonia Study Group – Japan |
| author_sort | Sugihiro Hamaguchi |
| collection | DOAJ |
| description | Abstract Background Mortality prediction of pneumonia by severity scores in patients with multiple underlying health conditions has not fully been investigated. This prospective cohort study is to identify mortality-associated underlying health conditions and to analyse their influence on severity-based pneumonia mortality prediction. Methods Adult patients with community-acquired pneumonia or healthcare-associated pneumonia (HCAP) who visited four community hospitals between September 2011 and January 2013 were enrolled. Candidate underlying health conditions, including demographic and clinical characteristics, were incorporated into the logistic regression models, along with CURB (confusion, elevated urea nitrogen, tachypnoea, and hypotension) score as a measure of disease severity. The areas under the receiver operating characteristic curves (AUROC) of the predictive index based on significant underlying health conditions was compared to that of CURB65 (CURB and age ≥ 65) score or Pneumonia severity index (PSI). Mortality association between disease severity and the number of underlying health conditions was analysed. Results In total 1772 patients were eligible for analysis, of which 140 (7.9%) died within 30 days. Six underlying health conditions were independently associated: home care (adjusted odds ratio, 5.84; 95% confidence interval, CI, 2.28–14.99), recent hospitalization (2.21; 1.36–3.60), age ≥ 85 years (2.15; 1.08–4.28), low body mass index (1.99, 1.25–3.16), neoplastic disease (1.82; 1.17–2.85), and male gender (1.78; 1.16–2.75). The predictive index based on these conditions alone had a significantly or marginally higher AUROC than that based on CURB65 score (0.78 vs 0.66, p = 0.02) or PSI (0.78 vs 0.71, p = 0.05), respectively. Compared to this index, the AUROC of the total score consisting of six underlying health conditions and CURB score (range 0–10) did not improve mortality predictions (p = 0.3). In patients with one or less underlying health conditions, the mortality was discretely associated with severe pneumonia (CURB65 ≥ 3) (risk ratio: 7.24, 95%CI: 3.08–25.13), whereas in patients with 2 or more underlying health conditions, the mortality association with severe pneumonia was not detected (risk ratio: 1.53, 95% CI: 0.94–2.50). Conclusions Mortality prediction based on pneumonia severity scores is highly influenced by the accumulating number of underlying health conditions in an ageing society. The validation using a different cohort is necessary to generalise the conclusion. |
| first_indexed | 2024-12-19T03:53:16Z |
| format | Article |
| id | doaj.art-dd9c2fc6062c4bbe8d520d978298eec8 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-19T03:53:16Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-dd9c2fc6062c4bbe8d520d978298eec82022-12-21T20:36:54ZengBMCBMC Pulmonary Medicine1471-24662018-05-0118111010.1186/s12890-018-0648-ySix underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort studySugihiro Hamaguchi0Motoi Suzuki1Kota Sasaki2Masahiko Abe3Takao Wakabayashi4Eiichiro Sando5Makito Yaegashi6Shimpei Morimoto7Norichika Asoh8Naohisa Hamashige9Masahiro Aoshima10Koya Ariyoshi11Konosuke Morimoto12on behalf of The Adult Pneumonia Study Group – JapanDepartment of General Internal Medicine, Fukushima Medical UniversityDepartment of Clinical Medicine, Institute of Tropical Medicine, Nagasaki UniversityDepartment of Laboratory Medicine, Ebetsu City HospitalDepartment of General Internal Medicine, Ebetsu City HospitalDepartment of General Medicine, Sapporo Hokushin HospitalDepartment of Clinical Medicine, Institute of Tropical Medicine, Nagasaki UniversityDepartment of General Internal Medicine, Kameda Medical CentreInnovation platform & office for precision medicine, Nagasaki University Graduate School of Biomedical SciencesDepartment of Internal Medicine, Juzenkai HospitalDepartment of Internal Medicine, Chikamori HospitalDepartment of Pulmonology, Kameda Medical CentreDepartment of Clinical Medicine, Institute of Tropical Medicine, Nagasaki UniversityDepartment of Clinical Medicine, Institute of Tropical Medicine, Nagasaki UniversityAbstract Background Mortality prediction of pneumonia by severity scores in patients with multiple underlying health conditions has not fully been investigated. This prospective cohort study is to identify mortality-associated underlying health conditions and to analyse their influence on severity-based pneumonia mortality prediction. Methods Adult patients with community-acquired pneumonia or healthcare-associated pneumonia (HCAP) who visited four community hospitals between September 2011 and January 2013 were enrolled. Candidate underlying health conditions, including demographic and clinical characteristics, were incorporated into the logistic regression models, along with CURB (confusion, elevated urea nitrogen, tachypnoea, and hypotension) score as a measure of disease severity. The areas under the receiver operating characteristic curves (AUROC) of the predictive index based on significant underlying health conditions was compared to that of CURB65 (CURB and age ≥ 65) score or Pneumonia severity index (PSI). Mortality association between disease severity and the number of underlying health conditions was analysed. Results In total 1772 patients were eligible for analysis, of which 140 (7.9%) died within 30 days. Six underlying health conditions were independently associated: home care (adjusted odds ratio, 5.84; 95% confidence interval, CI, 2.28–14.99), recent hospitalization (2.21; 1.36–3.60), age ≥ 85 years (2.15; 1.08–4.28), low body mass index (1.99, 1.25–3.16), neoplastic disease (1.82; 1.17–2.85), and male gender (1.78; 1.16–2.75). The predictive index based on these conditions alone had a significantly or marginally higher AUROC than that based on CURB65 score (0.78 vs 0.66, p = 0.02) or PSI (0.78 vs 0.71, p = 0.05), respectively. Compared to this index, the AUROC of the total score consisting of six underlying health conditions and CURB score (range 0–10) did not improve mortality predictions (p = 0.3). In patients with one or less underlying health conditions, the mortality was discretely associated with severe pneumonia (CURB65 ≥ 3) (risk ratio: 7.24, 95%CI: 3.08–25.13), whereas in patients with 2 or more underlying health conditions, the mortality association with severe pneumonia was not detected (risk ratio: 1.53, 95% CI: 0.94–2.50). Conclusions Mortality prediction based on pneumonia severity scores is highly influenced by the accumulating number of underlying health conditions in an ageing society. The validation using a different cohort is necessary to generalise the conclusion.http://link.springer.com/article/10.1186/s12890-018-0648-yUnderlying health conditionsAdult pneumoniaAgeing populationMortality prediction |
| spellingShingle | Sugihiro Hamaguchi Motoi Suzuki Kota Sasaki Masahiko Abe Takao Wakabayashi Eiichiro Sando Makito Yaegashi Shimpei Morimoto Norichika Asoh Naohisa Hamashige Masahiro Aoshima Koya Ariyoshi Konosuke Morimoto on behalf of The Adult Pneumonia Study Group – Japan Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study BMC Pulmonary Medicine Underlying health conditions Adult pneumonia Ageing population Mortality prediction |
| title | Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study |
| title_full | Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study |
| title_fullStr | Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study |
| title_full_unstemmed | Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study |
| title_short | Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study |
| title_sort | six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of japan a prospective cohort study |
| topic | Underlying health conditions Adult pneumonia Ageing population Mortality prediction |
| url | http://link.springer.com/article/10.1186/s12890-018-0648-y |
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