Chest
Original ResearchPneumoniaValidity of Severity Scores in Hospitalized Patients With Nursing Home-Acquired Pneumonia
Section snippets
Study Population
The Institutional Review Board approved the study and waived the need for informed consent. All nursing home patients presenting to one of the study hospitals (Erie County Medical Center and Millard Fillmore Hospital) with pneumonia were abstracted from a database collected prospectively. Exclusion criteria were as follows: (1) acquisition of pneumonia after hospital admission; (2) hospitalization in the last 90 days; (3) chemotherapy during the previous 60 days, therapy with corticosteroids >
Patient Population
A total of 478 patients with NHAP were identified. Eighteen patients were excluded because pneumonia occurred as a terminal event or the patient had clear advance directives limiting therapy. An additional three patients fit the definition of immunosuppression. Four hundred fifty-seven patients of mean age 77.4 years were available for analysis. The baseline demographic and clinical characteristics are shown in Table 1. One hundred twelve (25%) required ICU admission; 101 were admitted directly
Discussion
The results of this study demonstrate that SOAR has a superior discriminatory power compared with CURB, CURB-65, and CRB-65 in predicting ICU admission and 30-day mortality from NHAP. The current study is the first, to our knowledge, to examine the accuracy of CURB and its derivatives in patients with NHAP. Previously, Mylotte and colleagues19 established that the pneumonia severity index successfully stratified low- and high-risk groups for 30-day mortality in a cohort of 158 pneumonic
Acknowledgments
Author contributions: Dr El-Solh: contributed to concept and design, analysis and interpretation of data, and final revision of the manuscript.
Dr Alhajhusain: contributed to acquisition and tabulation of data.
Dr Abou Jaoude: contributed to acquisition and tabulation of data.
Dr Drinka: contributed to critical revision of the manuscript for important intellectual content.
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any
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Cited by (29)
Clinical features, therapy and outcome of patients hospitalized or not for nursing-home acquired pneumonia
2020, Journal of Infection and ChemotherapyCitation Excerpt :Clinical pathway to implement treatment of NHAP were reported with reduction of hospitalizations by 12%, without affecting mortality, functional status, or health-related quality of life [3]. Several studies have suggested considering NHAP as a distinct entity with peculiar risk factors and outcomes [4–6]: frail elderly patients frequently reside in LTCF and the peculiar features of this population have led NHAP to be considered a separate clinical entity, thereby justifying specific recommendations for clinical management in international guidelines [7]. However, etiology of NHAP has not been definitely assessed and includes a wide spectrum of pathogens from those involved in community-acquired pneumonia to those usually associated with healthcare-associated infections [8,9].
Predictors of mortality in nursing-home residents with pneumonia: a multicentre study
2018, Clinical Microbiology and InfectionCitation Excerpt :Several studies have suggested considering NHAP as a distinct entity with peculiar risk factors and outcomes [3–5]: frail elderly patients often reside in LTCFs, and the peculiar features of this population have led NHAP to be considered a separate clinical entity, thereby justifying specific recommendations for clinical management in international guidelines [6]. The aetiology of NHAP has not been definitely assessed and includes a wide spectrum of pathogens from those involved in community-acquired pneumonia to those usually associated with healthcare-associated infections [4,7,8]. Furthermore, very few studies have evaluated risk factors and markers of severity of pneumonia in NH/LTCF residents [5,9,10].
Infections in the Elderly
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious DiseasesCarboxy-terminal provasopressin may predict prognosis in nursing home acquired pneumonia
2013, Clinica Chimica ActaCitation Excerpt :In this study, we found copeptin associated with 30-day mortality in HNAP patients, while pro-ANP and procalcitonin were not. In predicting mortality, copeptin was equivalent to CURB-65, which was originally developed for the estimation pneumonia mortality to help determine the need for inpatient versus outpatient antibiotic therapy in patients with CAP [15] and has been proven to be applicable to NHAP patients [41,42]. Copeptin may be useful in predicting NHAP prognosis, encompassing various stressful conditions (inflammation, cardiovascular dysfunction, respiratory failure).
Common questions about pneumonia in nursing home residents
2015, American Family PhysicianCitation Excerpt :A score of 2 or more is associated with a significantly higher 30-day mortality rate (33% mortality or greater vs. less than 8% mortality for a score of 1 or 0).60
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