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Incremental risk of long-term mortality with increased burden of comorbidity in hospitalized patients with pneumonia

      Highlights

      • Described the process of selection of 20 most prevalent comorbid conditions in US population
      • Added a sub-heading “selection of comorbid conditions” in methods section
      • As suggested by reviewer #1, we condensed manuscript for possible publication as a short paper.
      • As suggested by reviewer #2, we removed the repetitions.
      • As suggested by reviewer #2, we condensed the limitations and strength portion of the discussion.

      Abstract

      Background

      Patients hospitalized for pneumonia often have concurrent comorbid conditions (CCs). The influence of CCs on the risk of subsequent death is not fully understood.

      Methods

      We examined adults hospitalized for pneumonia between 1996 through 2015 at Mayo Clinic for the presence of 20 priori selected CCs. We estimated cumulative all-cause mortality by number of CCs using multivariable Cox regression model.

      Results

      Study comprised of 9580 adults (age 70 ± 17.0 years, men 53%, whites 88%) with median number of CCs 3 (interquartile 1–4), and overall deaths 6032 (62.9%) during 50,934 person-years of follow up (118.5 deaths/1000 person-years). After adjustment, any single comorbid condition was associated with 9% greater risk of death (95% confidence interval 1.08–1.11, P < 0.0001). When study cohort was stratified according to number of comorbidities (none, 1, 2, 3, 4, 5, and ≥6 CCs), the risk of death increased as the number of CCs increased (33 for no CCs vs 252 deaths for ≥6 CCs per 1000 person-years).

      Conclusions

      Long-term mortality after hospitalization for pneumonia increases as the burden of comorbidities increases. Therefore, a simple comorbidity count help improve prognostic accuracy in identifying patients at increased risk of death following an episode of pneumonia.

      Keywords

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