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An investigation of multimorbidity measures as risk factors for pneumonia in elderly frail patients admitted to hospital

  • Andrea Ticinesi
    Affiliations
    Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy

    Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
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  • Antonio Nouvenne
    Correspondence
    Corresponding author at: Internal Medicine and Critical Subacute Care Unit, Parma University Hospital and University of Parma, Department of Clinical and Experimental Medicine Via Antonio Gramsci 14, 43126 Parma, Italy. Tel.: +39 0521 703626; mobile: +39 3492258317; fax: +39 0521 702383.
    Affiliations
    Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy

    Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
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  • Giuseppina Folesani
    Affiliations
    INAIL - CERT Research Center University of Parma, Parma, Italy
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  • Beatrice Prati
    Affiliations
    Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
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  • Ilaria Morelli
    Affiliations
    Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
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  • Loredana Guida
    Affiliations
    Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
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  • Fulvio Lauretani
    Affiliations
    Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy

    Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
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  • Marcello Maggio
    Affiliations
    Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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  • Tiziana Meschi
    Affiliations
    Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy

    Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy
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Published:December 10, 2015DOI:https://doi.org/10.1016/j.ejim.2015.11.021

      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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