Predictors of mortality in nursing-home residents with pneumonia: A multicentre study

M. Falcone, A. Russo, F. Gentiloni Silverj, D. Marzorati, R. Bagarolo, M. Monti, R. Velleca, R. D'Angelo, A. Frustaglia, G. C. Zuccarelli, R. Prina, M. Vignati, M. G. Marnati, M. Venditti, M. Tinelli

Research output: Contribution to journalArticle

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Abstract

Objectives: To evaluate predictors of mortality in patients residing in nursing-homes (NHs) or long-term care facilities (LTCFs) with diagnosis of NH-acquired pneumonia (NHAP). Methods: We conducted an observational, prospective study (December 2013-December 2015) of patients residing in nine NHs/LTCFs of Central and Northern Italy with diagnosis of NHAP. Data on demographics, comorbidities, microbiology, and therapies were entered into an electronic database. To identify risk factors associated with 30-day mortality, we performed univariable and multivariable analyses, and predictors were internally validated using a bootstrap resampling procedure. We derived a prediction rule using the coefficients obtained from the multivariable logistic regression. The model obtained was assessed using the area under the receiver operating characteristic curve (AUROC). Results: Overall, 446 patients with NHAP were included in the final cohort. The median age was 80 (IQR 75-87) years. A definite aetiology was obtained in 120 (26.9%) patients; of these, 66 (55%) had a culture positive for a multidrug-resistant pathogen. The 30-day mortality was 28.7%. On multivariate analysis, malnutrition (OR 7.8; 95% CI 3-20.2, 2 points), bilateral pneumonia (OR 3.7; 95% CI 1.4-9.8, 1 point), acute mental status deterioration (OR 6.2; 95% CI 2.2-17.6, 2 points), hypotension (OR 7.7; 95% CI 2.3-24.9, 2 points), and PaO2/FiO2 ratio ≤250 (OR 7.4; 95% CI 2.2-24.2, 2 points) were independently associated with 30-day mortality. The derived prediction rule showed an AUROC of 0.83 (95% CI 0.78-0.87, p <0.001). Conclusions: NH residents with pneumonia have specific risk factors associated with 30-day mortality. Malnutrition and acute mental change appear as major determinants of death in this population.

Original languageEnglish
JournalClinical Microbiology and Infection
DOIs
Publication statusE-pub ahead of print - Jun 2017

Fingerprint

Nursing Homes
Multicenter Studies
Pneumonia
Mortality
Long-Term Care
ROC Curve
Malnutrition
Microbiology
Hypotension
Italy
Observational Studies
Comorbidity
Multivariate Analysis
Logistic Models
Demography
Databases
Prospective Studies
Population
Therapeutics

Keywords

  • Delirium
  • Elderly patient
  • Long-term care facility
  • Malnutrition
  • Nursing-home
  • Pneumonia

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Predictors of mortality in nursing-home residents with pneumonia : A multicentre study. / Falcone, M.; Russo, A.; Gentiloni Silverj, F.; Marzorati, D.; Bagarolo, R.; Monti, M.; Velleca, R.; D'Angelo, R.; Frustaglia, A.; Zuccarelli, G. C.; Prina, R.; Vignati, M.; Marnati, M. G.; Venditti, M.; Tinelli, M.

In: Clinical Microbiology and Infection, 06.2017.

Research output: Contribution to journalArticle

Falcone, M, Russo, A, Gentiloni Silverj, F, Marzorati, D, Bagarolo, R, Monti, M, Velleca, R, D'Angelo, R, Frustaglia, A, Zuccarelli, GC, Prina, R, Vignati, M, Marnati, MG, Venditti, M & Tinelli, M 2017, 'Predictors of mortality in nursing-home residents with pneumonia: A multicentre study', Clinical Microbiology and Infection. https://doi.org/10.1016/j.cmi.2017.05.023
Falcone, M. ; Russo, A. ; Gentiloni Silverj, F. ; Marzorati, D. ; Bagarolo, R. ; Monti, M. ; Velleca, R. ; D'Angelo, R. ; Frustaglia, A. ; Zuccarelli, G. C. ; Prina, R. ; Vignati, M. ; Marnati, M. G. ; Venditti, M. ; Tinelli, M. / Predictors of mortality in nursing-home residents with pneumonia : A multicentre study. In: Clinical Microbiology and Infection. 2017.
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abstract = "Objectives: To evaluate predictors of mortality in patients residing in nursing-homes (NHs) or long-term care facilities (LTCFs) with diagnosis of NH-acquired pneumonia (NHAP). Methods: We conducted an observational, prospective study (December 2013-December 2015) of patients residing in nine NHs/LTCFs of Central and Northern Italy with diagnosis of NHAP. Data on demographics, comorbidities, microbiology, and therapies were entered into an electronic database. To identify risk factors associated with 30-day mortality, we performed univariable and multivariable analyses, and predictors were internally validated using a bootstrap resampling procedure. We derived a prediction rule using the coefficients obtained from the multivariable logistic regression. The model obtained was assessed using the area under the receiver operating characteristic curve (AUROC). Results: Overall, 446 patients with NHAP were included in the final cohort. The median age was 80 (IQR 75-87) years. A definite aetiology was obtained in 120 (26.9{\%}) patients; of these, 66 (55{\%}) had a culture positive for a multidrug-resistant pathogen. The 30-day mortality was 28.7{\%}. On multivariate analysis, malnutrition (OR 7.8; 95{\%} CI 3-20.2, 2 points), bilateral pneumonia (OR 3.7; 95{\%} CI 1.4-9.8, 1 point), acute mental status deterioration (OR 6.2; 95{\%} CI 2.2-17.6, 2 points), hypotension (OR 7.7; 95{\%} CI 2.3-24.9, 2 points), and PaO2/FiO2 ratio ≤250 (OR 7.4; 95{\%} CI 2.2-24.2, 2 points) were independently associated with 30-day mortality. The derived prediction rule showed an AUROC of 0.83 (95{\%} CI 0.78-0.87, p <0.001). Conclusions: NH residents with pneumonia have specific risk factors associated with 30-day mortality. Malnutrition and acute mental change appear as major determinants of death in this population.",
keywords = "Delirium, Elderly patient, Long-term care facility, Malnutrition, Nursing-home, Pneumonia",
author = "M. Falcone and A. Russo and {Gentiloni Silverj}, F. and D. Marzorati and R. Bagarolo and M. Monti and R. Velleca and R. D'Angelo and A. Frustaglia and Zuccarelli, {G. C.} and R. Prina and M. Vignati and Marnati, {M. G.} and M. Venditti and M. Tinelli",
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T1 - Predictors of mortality in nursing-home residents with pneumonia

T2 - A multicentre study

AU - Falcone, M.

AU - Russo, A.

AU - Gentiloni Silverj, F.

AU - Marzorati, D.

AU - Bagarolo, R.

AU - Monti, M.

AU - Velleca, R.

AU - D'Angelo, R.

AU - Frustaglia, A.

AU - Zuccarelli, G. C.

AU - Prina, R.

AU - Vignati, M.

AU - Marnati, M. G.

AU - Venditti, M.

AU - Tinelli, M.

PY - 2017/6

Y1 - 2017/6

N2 - Objectives: To evaluate predictors of mortality in patients residing in nursing-homes (NHs) or long-term care facilities (LTCFs) with diagnosis of NH-acquired pneumonia (NHAP). Methods: We conducted an observational, prospective study (December 2013-December 2015) of patients residing in nine NHs/LTCFs of Central and Northern Italy with diagnosis of NHAP. Data on demographics, comorbidities, microbiology, and therapies were entered into an electronic database. To identify risk factors associated with 30-day mortality, we performed univariable and multivariable analyses, and predictors were internally validated using a bootstrap resampling procedure. We derived a prediction rule using the coefficients obtained from the multivariable logistic regression. The model obtained was assessed using the area under the receiver operating characteristic curve (AUROC). Results: Overall, 446 patients with NHAP were included in the final cohort. The median age was 80 (IQR 75-87) years. A definite aetiology was obtained in 120 (26.9%) patients; of these, 66 (55%) had a culture positive for a multidrug-resistant pathogen. The 30-day mortality was 28.7%. On multivariate analysis, malnutrition (OR 7.8; 95% CI 3-20.2, 2 points), bilateral pneumonia (OR 3.7; 95% CI 1.4-9.8, 1 point), acute mental status deterioration (OR 6.2; 95% CI 2.2-17.6, 2 points), hypotension (OR 7.7; 95% CI 2.3-24.9, 2 points), and PaO2/FiO2 ratio ≤250 (OR 7.4; 95% CI 2.2-24.2, 2 points) were independently associated with 30-day mortality. The derived prediction rule showed an AUROC of 0.83 (95% CI 0.78-0.87, p <0.001). Conclusions: NH residents with pneumonia have specific risk factors associated with 30-day mortality. Malnutrition and acute mental change appear as major determinants of death in this population.

AB - Objectives: To evaluate predictors of mortality in patients residing in nursing-homes (NHs) or long-term care facilities (LTCFs) with diagnosis of NH-acquired pneumonia (NHAP). Methods: We conducted an observational, prospective study (December 2013-December 2015) of patients residing in nine NHs/LTCFs of Central and Northern Italy with diagnosis of NHAP. Data on demographics, comorbidities, microbiology, and therapies were entered into an electronic database. To identify risk factors associated with 30-day mortality, we performed univariable and multivariable analyses, and predictors were internally validated using a bootstrap resampling procedure. We derived a prediction rule using the coefficients obtained from the multivariable logistic regression. The model obtained was assessed using the area under the receiver operating characteristic curve (AUROC). Results: Overall, 446 patients with NHAP were included in the final cohort. The median age was 80 (IQR 75-87) years. A definite aetiology was obtained in 120 (26.9%) patients; of these, 66 (55%) had a culture positive for a multidrug-resistant pathogen. The 30-day mortality was 28.7%. On multivariate analysis, malnutrition (OR 7.8; 95% CI 3-20.2, 2 points), bilateral pneumonia (OR 3.7; 95% CI 1.4-9.8, 1 point), acute mental status deterioration (OR 6.2; 95% CI 2.2-17.6, 2 points), hypotension (OR 7.7; 95% CI 2.3-24.9, 2 points), and PaO2/FiO2 ratio ≤250 (OR 7.4; 95% CI 2.2-24.2, 2 points) were independently associated with 30-day mortality. The derived prediction rule showed an AUROC of 0.83 (95% CI 0.78-0.87, p <0.001). Conclusions: NH residents with pneumonia have specific risk factors associated with 30-day mortality. Malnutrition and acute mental change appear as major determinants of death in this population.

KW - Delirium

KW - Elderly patient

KW - Long-term care facility

KW - Malnutrition

KW - Nursing-home

KW - Pneumonia

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