Highlights
- •Multimorbidity is an independent risk factor for pneumonia in the elderly.
- •CIRS Comorbidity Score may be useful to define this risk.
- •COPD and dementia are the main contributors to this association.
- •Traditional risk factors, like cancer or diabetes, play a minor role in this population.
Abstract
Objectives
To investigate the association of different chronic comorbidities, considered singularly
and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis
in a group of elderly frail hospitalized patients.
Design and methods
With a retrospective cohort design, all clinical records of frail (Rockwood ≥5) nonterminal patients ≥65 years old acutely admitted over a 8-month span in an internal medicine ward were evaluated.
Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated,
HCAP) were defined according to chest radiology findings and validated criteria. Chronic
comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each
participant through a standardized methodology. Multivariate logistic regression models
were applied to assess the association of each comorbid condition or scores with pneumonia.
Results
1199 patients (546 M, median age 81.9, IQR 72.8–87.9 years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity
Score was significantly associated with pneumonia, both at an age- and sex-adjusted
model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001–1.062,
p = 0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41–2.73, p < 0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9–3.6, p < 0.001) and dementia (OR 2.3, 95% CI 1.7–3.3, p < 0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic
liver and kidney disease were not.
Conclusions
In a small cohort of elderly frail hospitalized patients, measures of multimorbidity,
like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia
are the main conditions concurring to define this risk.
Keywords
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Article info
Publication history
Published online: December 10, 2015
Accepted:
November 22,
2015
Received in revised form:
October 27,
2015
Received:
July 8,
2015
Footnotes
☆Funding sources and related paper presentations: All authors have no conflict of interest to declare. This research has been carried out with no extra-institutional funding. Preliminary results were presented at the 115th National Congress of the Italian Society of Internal Medicine (Società Italiana di Medicina Interna, SIMI), held in Rome, Italy, from October 25th to October 27th 2014.
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
